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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Permit Fees: a' ►+ <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commerciat/Industrial Building $2 <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse <br /> Accessory Structure-Commercial(C l&11) $200 Addition to Accessory Structure-Commercial(C 1&11) $200 <br /> Deck/Stairs/Patios \ <br /> $125 Gazebo WI Stat 59.692(l v)) $350 0 1 <br /> Camping Unit $100 Filling/Grading $150 1�' <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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory stntchtres,such as:pergolas, landscaping,retaining malls. <br /> Applicant Complete All Sections Below This Line c �. <br /> Applicant's Name: +- a-- \eCXq\,q <br /> e <br /> r <br /> Applicant's Mailing Address: "1�� +t SC 1-(\. `N;rP_ f l.a\<'p M SSW <br /> City 9tate Zip b <br /> PP P CnS (" o�I�"Oy aG �ecry Cr?l, z <br /> Applicant's s Tele hone Number: . H '� <br /> 2. <br /> Applicant's Email: <br /> w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> [-]Letter ❑Phone mail N 00 <br /> Legal Description: ` / I <br /> Lot#:_7 CSM Vol. Pg. ii OR et 5� <br /> n' <br /> Lot#: Subdivision Name: C OR rn 1 <br /> Gov't Lot#:W OR 1/4 1/4 o <br /> Section#:_A4 Town#:_ql _N Range#:__\_Z_W Town of: 1_::;Ld%S S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed.* v <br /> Parcel#(24 digits): w <br /> Tax ID#(1-5 digits): r) z <br /> Property Site Address#: y <br /> z <br /> Road Name: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec�leBQ <br /> ❑ Single Family Dwelling L3 Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition LJ J <br /> n C <br /> p Q_MMq%M c�.b'l n 03 : � <br /> Proposed Structure/Addition Use: � D <br /> (� 1 (` Lt <br /> Home/ ;CommZ <br /> Commercial Business:Bedroom;Deck;etc.) \ Z <br /> Building Contractor: Pm �V t�� —I l�V^cA, we 4--ZMq -t�S Y�u_-0_ <br /> v � <br /> Anticipated Start Date:�C�� �MGV ( pyO �Q o f� <br /> Page 1 of 4 o Z1�U <br /> Burnett County,WI Land Use Application—Rev 3/2015 <br /> 3 <br /> x <br /> m <br /> F <br /> m <br />