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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> y � ' <br /> N ~, <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwellin Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 a <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> a' <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> m <br /> *Items not listed above will be treated as accesso structures,such as:pergolas,landscaping, retaining walls. <br /> 'v <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name* l �, 1� , <br /> Applicant's Mailing Address: ► -' C �V <br /> City State Zip o <br /> Applicant's Telephone Number. o r <br /> Applicant's Email; 0(\1e�\L'n 40 QeJ` t CA2)- Y1 p <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ao <br /> ❑Letter NPhone ❑Email N <br /> 0 <br /> Legal Description: 'OQ <br /> y <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR 1 r„ <br /> Gov't Lot# 1L OR 1/4 1/4 <br /> Section#: Town#: N Range#:-/&—W Town of: �� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H <br /> Parcel#(24 digits): d :� — OQO—a "76 — AP-51 <br /> 2 z <br /> Tax ID#(1-5 digits):�M�—f N � <br /> Property Site Address#: a�OMo 11 ll y <br /> Road Name: �c ai k SWon City: t eB—Ke Q! <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Re( <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling 0 Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition C <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N z <br /> ElPermit Extension ElGazebo—WI Stat 59.692(ly) LlCamping Unit L3Commercial Acc. Addition �m C <br /> Proposed Structure/Addition Use: ero <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^) <br /> Building Contractor: { Z <br /> Anticipated Start Date: =J <br /> Page 1 of 4 0 <br /> m <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 9 <br /> X <br /> M <br /> X <br /> M <br />