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LAND USE PERNHT APPLICATION — Burnett County, WI ro r <br /> Permit Fees: °o g <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 0 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Accessory Structure or Bunkhouse $250 ] <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios 1 $125 1 Gazebo(WI Stat 59.692(l v)) $350 0 7_�J <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. � <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '- <br /> m^ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. 2 <br /> ro <br /> Applicant ComTete All Sections Below This Line �. <br /> � o <br /> Applicant's Name: r t <br /> Applicant's Mailing Address: FOO go,)( t0 S� O r ✓zt r t Q n 9/ <br /> City State Zip z <br /> Applicant's ant's TelePhone Number: J 57 77 7( ro_ <br /> o y <br /> Applicant's Em ail: �GQ K l0 W_ it " eta Ile r vi ets Pj4P ,f o i <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter Phone ❑Email N a4 <br /> Legal Description: OQ' 1 <br /> Lot#: CSM Vol. a5 Pg.Lt3OR <br /> Lot#: Block#: Subdivision Name:-[ OR 5 <br /> � 1 <br /> Gov't Lot#: OR 1/4 MLk) 1/4 <br /> Section#: )b Town#: Iff <br /> N Range#: �W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y <br /> Parcel#(24 digits): I <br /> Tax ID#(1-5 digits): // y J <br /> Property Site Addre #• `I y I G <br /> Road Name: o City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recd-s—MOD <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> 0 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> L3Permit Extension Gazebo-WI Stat 59.692(ly) ElCamping Unit ❑ Commercial Acc.Addition z to Q <br /> C <br /> NZ <br /> Proposed Structure/Addition Use: rm > Z C <br /> ((Ho /Cabin;Commercial Business:Bedroom;Deck;etc.) ZN Z <br /> Building Contractor: k." 1 Vl �Yl ! <br /> fy <br /> Anticipated Start Date: ! /6, J/5- <br /> C: <br /> Page 1 of 4 0Z� <br /> Burnett County,WI Land Use Application—Rev 3/2015 <br /> m <br /> m <br /> m <br />