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LAND USE PERMIT APPLICATION — Burnett Count, WI <br /> G <br /> ro <br /> m <br /> Permit Fees: <br /> Dwellin rind al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwellin rind al Building-Multi-Family $300 Addition to Dwelling/Principal Buildin -Multi-Famfl $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> m <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &II $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 l <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year.-Only 1 Allowed $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> v <br /> Applicant Complete All Sections Below This Line <br /> Z <br /> Applicant's Name: <br /> *� �/a) Rp <br /> Applicant's Mailing Address:17/ K 9 78 f S Ala) , W City // tate zip <br /> Applicant's Telephone Number: �� "� 3P`�JbJ C t�'T f�=b$°�r 92 9 0 " <br /> Applicant's Email: J LM K6) -a Ftm&rTi m cam o O� <br /> w n' <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> I ❑Letter hone ❑Email .y� pQA T w l <br /> Legal Description: d IV!2. VW j ur�'C �� L CJ� lyb `N &1r f I. � <br /> Lot#: CSM Vol. Pg. OR n <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 4i F <br /> Section#: Town#: '%L') N Range#:_/rW Town of: tJPO[7-XJ;Z)fV <br /> *Attach additionalpage i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e. <br /> PaS f .f g Y P PY f Y P P tY P g <br /> Parcel#(24 digits): <br /> X <br /> Tax ID#(1-5 digits): fyv�q r z <br /> N <br /> Property Site Address#: a-'W Z T r f <br /> Road Name: R40, City: 6a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:L <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling LIFilling/Grading Ll Commercial Building <br /> WO <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition a <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 C <br /> L) <br /> p <br /> Proposed Structure/Addition Use: 457VR Pr&& 'y Z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> M <br /> Building Contractor: ,8C4ICN�- iCQ�'� <br /> � UUt��LLtt <br /> /� n _ t� <br /> Anticipated Start Date: ( CD <br /> T �� l D ! m C <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 > C� <br /> M <br /> W <br /> M <br />