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LAND USE PERMIT APPLICATION—Burnett County, WI 1 <br /> a b <br /> cl <br /> y y <br /> Permit Fees: <br /> a � <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 V i <br /> Commercial/Industrial Building 5300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &Il $200 Addition to Accessory Structure-Commercial Cl &11 $200 l <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692(Iv)) $350 <br /> Camping Unit $100 Filling/Grading $150 .�' <br /> Yk <br /> Permit Extension Valid for one year-Only 1 Allowed $100 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 accesso7y structures,such as:perpolas, landscaping,retaining walls. <br /> b <br /> Applican Complete All Sections Below This Line �. <br /> r 0 <br /> Applicant's Name: I <br /> Applicant's Mailing Address: 61 Y' L C+ UyltO t,4v eS Mil") <br /> / �5t� ` � 72 City State � <br /> Zip <br /> PPTelephone 3Vt) 1� O c y <br /> Applicant's Number: <br /> �,d' ��9p� R <br /> Applicant's Email 1 '��'(��.la'�"{'1^t S k Cow,,- <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ,phone mail <br /> o ' <br /> Legal Description: <br /> Lot CSM Vol. Pg. OR G <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of i <br /> *Attach additional page if needed far lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y 1 <br /> Parcel#(24 digits): Q�–O?JLI-Z-37– 1V OL`�'- aS'&)- d Z l 00 I <br /> Q <br /> Tax ID#(1-5 digits): 32(-, 10 ❑ z � k1 <br /> Or. <br /> �1 <br /> Property Site Address#: L & p-5�Y)AM \ -r V r y <br /> Road Name: &rr yrZt/✓\ City: <br /> TYPE OF PERMrr(S): Check appropriate box/boxes Fee Re( J <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling j>slFilling/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 m <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) 0 Camping Unitas ❑ Commercial Acc.Addition 0 C <br /> Proposed Structure/AdditionUse: dnd—lJ, AD i- 2 <br /> (Home/Cab n;Commercial Business;Bedroom;Deck;etc.) N Z /� <br /> q�J o `G t) <br /> 0D <br /> Building Contractor: /////��E � <, 0 <br /> O <br /> GN C==Anticipated Start Date: .rj/ ��// ) o <br /> Uri <br /> Page 1 of 4 Z 1'If <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> �J <br />