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LAND USE PERMIT APPLICATION —Burnett County, WI ro <br /> t b <br /> y N <br /> Permit Fees: a" <br /> Or <br /> ul� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 ;\ O <br /> Dwellin rinci 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 1 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial(C1 &11) $200 <br /> a- <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 9 to <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 c <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. ~r <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> z <br /> Applicant's Name: 2c� ° <br /> Applicant's Mailing Address: ✓/ <br /> City State Zip n„ <br /> Applicant's Telephone Number: O <br /> Applicant's Email: A-� ___CD/�1JryY C17G�r 1�/�-G�1f71 I_ d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑LetterI'hone Email b <br /> Legal Description: ; W <br /> Lot#: CSM Vol. Pg. OR r P O <br /> i <br /> Lot#: Block#: Subdivision Name: � R = Z <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: C V� <br /> Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .5 <br /> r o• � <br /> Parcel#(24 digits): J �J <br /> � CJ <br /> r <br /> Tax ID#(1-5 digits): z <br /> / / <br /> Property Site Address#: 37/2 vC�`/� /!- <br /> Road Name: City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee ReJS t❑ <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition a <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse E3 Commercial Acc. Structure <br /> ❑ Permit Extensionr❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition J l ) 1 <br /> —�� <br /> Proposed Structure/Addition Use: M <br /> (Home/Cabi ommercial Business;Bedroom:Deck:etc.) oN W <br /> M <br /> Building Contractor: <z o <br /> 9/�5=�01 �z 0 <br /> Anticipated Start Date: �O O ^' <br /> C <br /> Page 1 of 4 0 c" <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> a <br /> x <br /> a <br /> m <br />