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LAND USE PERMIT APPLICATION—Burnett County. WI a C <br /> Permit Fees: to <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &11 Addition to Accessory Structure-Commercial Cl&11) $200 � 1 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <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. I <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,landscaping,retaining walls. <br /> 'o <br /> Applicant Complete All Sections Below This Line o �. <br /> Dn <br /> l z <br /> Applicant's Name: )Gp u k;44k'e-1 <br /> Applicant's Mailing Address: <br /> City State Zip nn <br /> PP P ��� / /Z �� c5 {o 2 z <br /> Applicant's s Tele hone Number: o y � <br /> — e <br /> Applicant's Email: �� t <br /> d <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑LetterPhone ❑Email °0 ) <br /> 0 <br /> Legal Description: °g• I <br /> Lot#:_ CSM Vol. Pg. OR o <br /> 3. <br /> Lot#: Block# r„ <br /> C�—`Subdi sion Name: OR <br /> Gov't Lot#:�OR S 1/4 �V� 1/4 0 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additionalpage if n�eededfor lengthy description attach a copy of the deed OR attach tax system propertyPaBe. <br /> Parcel#(24 digits): 2)ZD * Qf <br /> J y <br /> z <br /> Tax ID#(1-5 digits): y � I <br /> Property Site Address#: 30%13 y <br /> Road Name:--f'Ahox, DKi(ve', City:Z)&,L)b q Wis <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 5b.m <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit 13Commercial Acc. Addition z <br /> Proposed Structure/Addition Use: S4-or–A5, gL" <br /> (Home/ abin;Commercial BusinAs_;Bedroom;Deck;etc.) Z <br /> n <br /> Building Contractor: iio <br /> MP0 en Plfl <br /> Anticipated Start Date: G)o o <br /> Page 1 of 4 a Z `r <br /> Burnett County, WI Land Use Application—Rev 4/2015 a --1 <br /> m <br /> A <br /> m <br />