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LAND USE PERMIT APPLICATION—Burnett County, W1 r <br /> a <br /> <' <br /> b <br /> Y. i <br /> Permit Fees: a a <br /> DwellingfPrincipat Building-Sin le Famil $300 Addition to Dwelling/Principal Building-Single Family $200 <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 Acc.StructureUj <br /> $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo WI Stat 59.692 lv) $350 91 <br /> Camping Unit $100 Filling/Grading $150 <' <br /> Permit Extension Valid for one year-Only I Allowed $100 c <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. rn / <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2. �/ ) <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas, landscaping, retainingwalls. <br /> ro <br /> m <br /> Applicant Complete All Sections Below This Line �. <br /> 7 0 <br /> Applicant's Name: S c J �q i7 11e.-., <br /> Applicant's Mailing Address: 2 Lf/od el 4Ae, <br /> Cite State Zip ro <br /> z <br /> Applicant's Telephone Number: 7/J-- 4/9/— 3 S_?'I— o d <br /> a <br /> Applicant's Email: C7 <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 N <br /> -0 <br /> Legal Description: IL <br /> fcj <br /> Lot#: CSM Vol. Pg. OR r <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> 1 <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> * l <br /> P8 ` .f 8Y P copy Y P P tYPB <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): Zy <br /> H <br /> Property Site Address#: J,292,k <br /> Road Name: A/dvr/ City: z>�7,,y A <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I <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 N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition z <br /> n <br /> Proposed Structure/Addition Use: C ltd <br /> y <br /> M <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) Z <br /> z <br /> , <br /> O � <br /> Building Contractor: ��/f Z <br /> to Z 0 an <br /> Anticipated Start Date: 4 , S, 0,/� t4 L7 O <br /> Page 1 of 4 fj Z <br /> Burnett County,WI Land Use Application—Rev 1/2016 > ' <br />