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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> ern= b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwell in rind al Building-Single Family $200 r O <br /> Dwellin lPrinci al Building-Multi-Familv $300 Addition to Dwellin rind al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 <br /> O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(CI &il) $200 Addition to Accessory Structure-Commercial(Cl&I1) $200 a <br /> Deck/Stairs/Patios $125 Ga ebo(WI Stat 59.692(lv)) $350 , t <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $loo r <br /> 0 <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 andfees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> 'o <br /> icartt Cgli�p(ete Allctj4ns t30�gW This l tete o F. <br /> Il a <br /> Applicant's Name: �-1 �b Q(C r f <br /> Applicant's Mailing Address: /rj7� S6y,d(,�Q d �j jr w g C � <br /> City State zip v <br /> Applicant's Telephone Number: �=j, 7 71 106ff / o <br /> Applicant's Email: C7 <br /> $J <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> l� <br /> ]Letter Phone ❑Email N <br /> Legal Description: NN <br /> A ((x) ' <br /> Lot#: CSM Vol. pg. OR ° t <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 .s <br /> Section#: _Town#: '10 _N Range#:� W Town of: a I� I 1 <br /> *Attach additionalpage i needed or lengthy description OR attach a co o the deed OR attach tax system ro er * y <br /> Pa8 .f f 8 Y P PY f Y P P ty page. <br /> ' 1 <br /> Parcel#(24 digits): r <br /> n z <br /> Tax ID#(1-5 digits): gZ I h x <br /> Property Site Address#: <br /> Road Name: City: l0/X <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec% l2 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ,Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Ll Acc. Structure(Non-bunkhouse) El Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: f uJapm <br /> (flomelrabin;Commercial Business;Bedroom;Deck,'etc) <br /> Z <br /> Building Contractor: . N M 5^- <br /> Anticipated Start Date: Z t �—4 coa u u u <br /> C=== <br /> Page 1 of 4 17 O o <br /> Burnett County,WI Land Use Application—Rev 4/2015 Z <br /> c <br />