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LAND USE PERMIT APPLICATION — Burnett County, WI a _ b <br /> N ^ <br /> N �1 <br /> Permit Fees: �n <br /> 6 <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwell in Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building S300 Addition to Commercial/Industrial Building $200 V o <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 _ <br /> Accessory Structure-Commercial(Cl &I1) Addition to Accessory Structure-Commercial C1 &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c <br /> Camping Unit Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v, <br /> d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> v <br /> Applicant Complete All Sections Below This Line S <br /> Z <br /> Applicant's Name: <br /> l <br /> Applicant's Mailing Address: `j j G,; j(� ���3� /� l� UJtl5W GLS ' <br /> City State Zip b <br /> S5/S's3 z <br /> Applicant's Telephone Number: / �Z/ " 7 71'V o y <br /> R <br /> a <br /> Applicant's Email: o <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter NPhone ❑Email �r <br /> Legal Description: jU 300, c7 r--T 90r <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 o i <br /> 1 7 <br /> Section#: �;Lq Town#:�0 N Range#: _W Town of: S�09 f i <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system property page. H <br /> '1 1 <br /> Parcel#(24 digits): 6'7- 039 - �'L'v-ILt-9-ci -S 05 -00/ -Q//60 <br /> Tax ID#(1-5 digits): 334(090-1, z d <br /> Property Site Address#: a 9 T7 c` t <br /> Road Name: 0,4K A A-ke <br /> TYPE OF PERMIT(S): Check appropriate box/boxes FeeRec: 05 a" <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building J77— <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition H <br /> "Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m �� <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition Z <br /> n I <br /> Proposed Structure/Addition Use: S 1 1/.e� <br /> (Name/Cabin;Commercial Business;Bedroom;Deck;etc.) `(✓/� <br /> ivy A Z <br /> Building Contractor. �; e � V L,Q j <br /> m <br /> Anticipated Start Date: <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> -o <br /> x <br /> m <br /> A <br /> M <br />