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LAND USE PERMIT APPLICATION— Burnett County WI C r <br /> N <br /> Permit Fees: <br /> Dwellin /Princi al Building-Single Family $300 Addition to DwellingiPtincipal Building-Single Family S200 O �l <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin /Princi al Building-Multi-Family $200 ( n �hY✓1 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Accessory Structure or Bunkhouse $250 - t <br /> Accessory Structure-Commercial(C1&11) $200 Addition to Accessory Structure-Commercial(C1&ll) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo(WI Stat 59.692(lv)) $350 CO <br /> Camping Unit $100 Filling/Gradin $150 <" <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 c <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, landmq in ,retaining walls. 2 <br /> 'v <br /> m <br /> AF <br /> n .({yam 1y/�`(J'���r5,1/.s�•{4 .' .. .m..�r1//�[y)!/yMo w O .".i <br /> Applicant's Name: 4M <br /> Applicant's Mailing Address: <br /> City State Zip <br /> 7 �h �, ( <br /> PP P �� '1�� J-4ti o � <br /> Applicant's Telephone Number: v <br /> ' � ��'1 1�4���1��1"� XVII IV �° LkJ•" 1 c. l <br /> Applicant s Email: C7 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> NLetter [`phone []Email °O <br /> Legal Description: <br /> Lot#: CSM Vol. P OR ° l <br /> Lot#: Subdivision Name: f' OR <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#: _Town#:3- Range#:J2 W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed. <br /> Parcel#(24 digits):O-/- <br /> Tax ID#(1-5 digits): i I � ❑ 7 <br /> N <br /> Property Site Addres #: y <br /> Road Name: f �' City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <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 G—=7 <br /> Proposed Structure/Addition Use: 156r�tl p_ C �_J�`=�+rJ <br /> H,r e/Cabi Commer ' l Bu Ines Bedroom;Deck;etc.) N Z 5 <br /> Building Contractor: S—V (l Z L� <br /> Anticipated Start Date: <br /> C� <br /> Page 1 of 4 Z <br /> Burnett County, WI Land Use Application—Rev 3/2015 <br />