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LAND USE PERMIT APPLICATION — Burnett County, WI a M< <br /> Permit Fees: r vi <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 d <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 g <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.6920v)) $350 G] 1 <br /> 0 <br /> < ' <br /> Camping Unit $100 Filling/Grading $150 - <br /> Permit Extension Valid for one year-Only l Allowed) $100 <br /> 0 <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 /> *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 /> Applicant's Name: y l Myp�tG� <br /> Applicant's Mailing Address: kirbee� r dee- t,&/.P -Wft 0�0 <br /> City State zip m <br /> Applicant's Telephone Number: 757 <br /> o � <br /> I - a � <br /> Applicant's Email: f 4Yk? 3, Owl &rlhDG <br /> ^p <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. SV <br /> w \ <br /> ❑Letter 21rhone ❑Email N --•- <br /> Legal Description: IV* WE i S(W* 5 <br /> Lot#: CSM Vol. Pg. OR to I <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#: 1*3 Town#:31 _N Range#:16W Town of: /'/eeH D/1 1 ° <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> � d <br /> Parcel#(24 digits): 07' 01f- :X- S !p- t6 ' t3-3- 01-000- D 11 Osb <br /> 0,C) z <br /> Tax ID#(1-5 digits): y <br /> Property Site.Address <br /> /ress#: <br /> Al/Ip� / / N <br /> Road Name: Bas R� City: Wef skl- kd' <br /> E <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Re3bo, <br /> U(Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure z <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> p �1�� > Z cry <br /> Proposed Structure/Addition Use: y Z <br /> M <br /> NM <br /> (No /Cabin;Commercial Business;Bedroom;Deck;etc.) z Z <br /> Building Contractor: �Lp ✓� , 2 0 0 <br /> AO O <br /> Anticipated Start Date: m : <br /> Page 1of4 o ual! <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> v <br /> x <br /> M <br /> F <br /> m <br />