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LAND USE PERMIT APPLICATION — Burnett County, WI a _ C <br /> N y Fy <br /> n <br /> Permit Fees: <br /> Dwcllin inti al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 - C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Budding $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 b <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory Structure-Commercial(Cl&Il) $200 Jj <br /> j� Deck/Stairs/Patios $125 Gazebo(Wl Slat 59.692(lv)) $350 0 1 <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 <br /> r r <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. <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. <br /> w <br /> *Items not listed above will be treated ac accessory structures,such as:pergolas, land ea pin ,retaining walls. Q <br /> pplicatitl omplete All Sections­rBelow Thi§11nio <br /> Applicant's Name: /,r) C-4 A?_ft &_(' <br /> Applicant's Mailing Address: r� ' 5-A -3� fh 14t/G ©Sc cc/c� 4411Z <br /> City State Zip b <br /> Applicant's Telephone Number: <br /> Cd <br /> a <br /> Applicant's Email: ;6-eld 9e.n f/e.-Cie wv a, ( • aw, p <br /> G <br /> (D <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone Email N O i <br /> Legal Description: ' <br /> Lot#: CSM Vol. Pg. OR o t <br /> "1 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:_3 OR 1/4 1/4 <br /> Section#: /a Town#: 31 N Range#: r'/ W Town of: I?CJsK <br /> *Attach additional page if needed for len&lhy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 07-0A Al -50 Y 00-3 - 0//000 r� <br /> z <br /> Tax ID#(1-5 digits): /573/ <br /> Property Site Adddress#: /q�Q c,;l-`�/Q <br /> Road Name: C._CJ R d (� City: 5�0_ n�r S�Bo J <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: -J• co <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Proposed Structure/Addition Use: Fr•c e yj tar.d i^3 ()e<-K 4r n wqr e l.e ^^�e�G;�cy ', Z n <br /> (Homeicabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor: ego <br /> O <br /> Anticipated Start Date: .S�///4 <br /> N <br /> C li"mCn <br /> Page 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br />