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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Permit Fees: 0 <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 at <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 CI &Il $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 lv) $350 o t <br /> Camping Unit $100 Filling/Grading $150 <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. v <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. J • <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. 1 <br /> �u <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: e S <br /> p <br /> Applicant's Mailing Address: <br /> // t� –/–7y 9�ity, State Zip <br /> , <br /> PP Telephone �Q (O�� _ L/� / < _ <br /> Applicant's s Tel hone Number: o r <br /> g. 1 <br /> Applicant's Email: o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter Phone ❑Email <br /> Legal Description: (' <br /> Lot#: CSM Vol. Pg. OR C <br /> Lot#::Block#: Subdivision Name: + OR i u I <br /> Gov't Lot#: OR 1/4 1/4 til rq!S:y-C31 <br /> Section Town#:3q--N Range#: Lk—W Town of:_ (S _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* (� <br /> W � <br /> Parcel#(24 digits): I l[�I//�' <br /> Tax ID#(1-5 digits): 1 (D 1 ,q d z <br /> Property Site Address#: I O y <br /> n <br /> Road Name: City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 5. <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑��Filling/Grading El Commercial Building z <br /> 13 Single Family Addition ❑ Multi-Family Addition eck/Patio ❑ Commercial Addition a <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N 0 <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition c <br /> i n <br /> Proposed Structure/Addition Use: <br /> I <br /> ( omAe/yCa'6i�n;Comm tial Business:Bedroom;Deck;etc.) <br /> Building Contractor: j u <br /> Anticipated Start Date: –5--/L,) u u u <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> 3 <br /> x <br /> n <br /> F <br /> T <br />