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LAND USE PERMIT APPLICATION — Burnett County, WI a _ <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 K <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 V O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 E <br /> m <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &11 $200 1Z ^ <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <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. w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ° <br /> w <br /> *Items not listed above will be treated as accessory structures,such as: er olas,landscaping,retaining walls. q <br /> ro <br /> Applicant Complete All Sections Below This Line c . <br /> Z <br /> Applicant's Name: , -im ) , <br /> 17 <br /> a / gy lr <br /> Applicant's Mailing Address: <br /> ( gCity State Zip <br /> Applicant's Telephone Number: ��/^ 3 �/ / 1 %C L o d <br /> a � <br /> Applicant's Email: o <br /> E <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. SE <br /> ❑Letter ❑Phone ❑Email c 0° <br /> Legal Description: AZ-( !t,e?k <br /> Lot#: CSM Vol. Pg. OR o <br /> 3. I <br /> Lot#: Block#: Subdivision Name: OR „ <br /> I <br /> Gov't Lot#: OR 1/4 1/4 Dj <br /> a <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property JPage.* -3 <br /> Parcel#(24 digits): 1 <br /> Tax ID#(1-5 digits): Q r y <br /> Property Site Address#: A9 J y Ver <br /> Road Name: \r-,C.j City: <br /> TY E OF PERMIT(S): Check appropriate box/boxes Fee Rec: 1 ,� <br /> gl a 11 c w n�j ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs cc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 4 W <br /> Proposed Structure/Addition Use: 1.A � L Z n <br /> (Cabin;Commercial Business;Bedroom;Deck;etc.) Rj <br /> Building Contractor: n <br /> N <br /> Anticipated Start Date: Z — z DI6 m C O <br /> Page 1 of cZ <br /> Burnett County,WI Land Use Application—Rev 1/2016 D� <br />