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LAND USE PERMIT APPLICATION-Burnett County, WI r <br /> Permit Fees: d <br /> Dwelling/Principal Budding-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin ci al Building-Multi-Family $200 <br /> CommerciaUindustrial Building $300 Addition to CommerciaVlndustdal Building $200 <br /> O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial(Cl&I l $200 <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692 lv $350 c <br /> Camping Unit $100 Fillin Gradin $150 <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed $100 R <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <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 /> ro <br /> z <br /> Applicant's Name: T11 xy�j C, 0C_.y--\ <br /> O <br /> Applicant's Mailing Address: <br /> City State Zip b <br /> Applicant's Telephone Number: <br /> Applicant's Email: r(I e(.CI'1A+t 1'Y) � '�(Q('1 bCl C G <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> n � <br /> ❑Letter (Phone ®Email 0 1 <br /> Legal Description: 17t _ F_(t2 6w Ltd Z <br /> l <br /> Lot CSM Vol._ Pg. OR H <br /> Lot#: Block#: Subdivision Name: OR h� <br /> Gov't Lot#: OR 1/4 1/4 - <br /> Section#: Town#: N Range#: W Town of I 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y V? I i <br /> Parcel#(24 digits): 6`1 O S- t7ZZ Q 1 c\b0(_-3 r- <br /> 1 <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: �to(v y <br /> Road Name: f (a KAZ Q n a-4 q, City:I - "LDU YX n w I <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec-3 ,0 <br /> *Single Family Dwelling ❑ Mufti-Family Dwelling ❑ Filling/Grading ❑ Commercial Building � <br /> y <br /> ❑ Single Family Addition ❑ Mufti-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> 0 <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition Q <br /> C, C <br /> Proposed Structure/Addition Use: G:� <br /> y ZI Cf) <br /> (Home/Cabm:Commercial Business;Bedroom;Deck;etc.) Z r'0 <br /> Building Contractor: _ c U <br /> 0 N <br /> Anticipated Start Date: i O <br /> Page 1 of 4 Z f <br /> Burnett County,WI Land Use Application—Rev 4/2015 �' <br />