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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> y ~ <br /> Pewmit Fees: ; to <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 Dwellin rinci al Building-Multi-Family $200 K <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial CI &11) $200 t <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 o U \1 <br /> Camping Unit $100 Filling/Grading $150 <br /> o <br /> Permit Extension Valid for one year-Only l Allowed $100 �-- <br /> *NOTE: After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w �I <br /> *Communication Towers&Signs require a different applicationform,see corresponding application andfees. �• <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> a <br /> Applicant Complete All Sections Below This Line <br /> z <br /> Applicant's Name: <br /> Applicant's Mailing Address: «C :5Y01 <br /> City State zip cr'i p ) <br /> i - 5-3 z <br /> Applicant's Telephone�Number: l02 -74 �3 C- <br /> Applicant's Email: <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email o °` 1 <br /> Legal Description: Sl=� / mT_L xkta <br /> Lot#: CSM Vol. Pg. OR l� <br /> S. <br /> Lot#: Block#: Subdivision Name: OR = 1 <br /> Gov't Lot#: OR 1/4 1/4 ' <br /> Section#: Town#: N Range#: W Town of: ) v 1 <br /> *Attach additional page f needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> Pg .r f 8Y P copy Y P P tYPg <br /> Parcel#(24 digits): V 7 —O� - 3°/ -i�/ - io-5©s oo C - C/o 1/000 <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: S cn_, _ <br /> Road Name: F�T ale � L-1wf `�. City: Se40ot LIF42 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: _{J9 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building Ri <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition En <br /> 0 <br /> ❑ Stairs AAcc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> 0 <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z CD <br /> Proposed Structure/Addition Use: /PoLE �C✓ z v <br /> (Home/Cabin;Commercial Rusin ss;Bedroom;Dec •etc.) -n <br /> g 6401 �. _j_AjF ��GcJit� Z o r <br /> Building Contractor: ? <br /> / Z0 � <br /> 17C <br /> Anticipated Start Date: m <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application — Rev 4/2015 D � <br /> m <br />