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LAND USE PERMIT APPLICATION — Burnett County, WI C <br /> N ^ <br /> N �1 <br /> Permit Fees: 0 r ut <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le FamilySO$200 � C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 SJ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 O <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl&I1) $200 <br /> Deck/Stairs/Pados $125 Gazebo WI Stat 59.692(l v)) $350 o <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas, landscaping, retainingwalls. <br /> 'v <br /> Applicant Complete All Sections Below This Line . <br /> Applicant's Name: <br /> l <br /> Applicant's Mailing Address: '740f16 5� ? -k <br /> City State Zip b <br /> , � z <br /> Applicant's Telephone Number: -f/i�-n;Jci-P t j 7 <br /> a \_ <br /> Applicant's Email: �] �(n d y ,(W(1 /. <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. QD <br /> ❑Letter Phone Email N <br /> 0 <br /> Legal Description: ' ) <br /> Lot#: CSM Vol. Pg. OR o <br /> N <br /> S <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR_S_1/4 NIC,- 1/4 <br /> Section#: Town#: N Range#:---j-(p_W Town of: N&y(146/1 <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> PB .fqq f 8Y P copy Y P P t3'P8 <br /> Parcel#(24 digits): 0e;:1—�- of l <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: as 9 /� ( N <br /> Road Name: S. I�,(A� City: I`�CITU{(� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rede <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 C <br /> ❑ Permit Extension ❑ Gazeboo-�-W,,I/IStat 59.692(ly) ❑ Camping Unit LlCommercial Acc.Addition z �1 <br /> Proposed Structure/Addition Use: ek <br /> (Home/Cabin;Commercial iness;Bedroom;Deck;etc.) V U U <br /> 1 0 <br /> Building Contractor: &AV-10 4 CJlnVI-(A 1 O o <br /> C Ln <br /> x <br /> Anticipated Start Date: <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> 3 <br /> x <br /> n <br /> A <br />