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LAND USE PERMIT APPLICATION—Burnett County,WI a <br /> Permit Fees: e g <br /> Dwelling/Principal Building-Single Famil $300 Addition to Dwelli ci al Building-Single Famil 5200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwdl' - i al Building-Multi-Family $200 v <br /> Commercial/Industrial Building Addition to CommerciaVlndustnal Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 unkhouse S250 <br /> i K <br /> Accessory Struchve-Commercial Cl &11) Addition to Accessory Structure-Commercial Cl&11 $200 <br /> Deck/Stairs/Patios $125 Gazebo(WlSta159.692lv)) S354) c t <br /> Camping Unit $100 Fill' Gradin $150 <br /> Permit Extension(Valid for one ear-Only 1 Allowed $loo `~ V <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <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 /> Applicant Complete All Sections Below This Line o . <br /> M / <br /> Applicant's Name: >''f/ (,lQCT / <br /> Applicant's Mailing Address: S ��� ,C�u/>/S �i'� �t(✓)�CIY�/ ` � SY��� <br /> City State Zip ro <br /> Applicant's Telephone Number: 71 <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 w <br /> ❑Letter ❑Phone (Email o <br /> Legal esction: gLt(IS � & LO f 4 <br /> Lot _ M 5g. <br /> OR g 1 <br /> �. Ul <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 416 1/4 56 1/4 <br /> Section#: _ _` Town#: %y/ N Range#: W Town of _5&0/,5 S / <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 0 7- o3). <br /> Tax ID# I-5 digits): m z <br /> y <br /> Property Site Address#: j 0 <br /> Road Name ���t i t City: J R/I 1 t <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:A0 <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑Filling/Grading ❑Commercial Building <br /> v, <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑Deck/Patio ❑Commercial Addition o <br /> ❑Stairs 0 Acc.Structure(Non-bunkhouse) L3 Bunkhouse ❑Commercial Acc.Structure m <br /> N <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(Iv) ❑Camping Unit ❑Commercial Aa.Addition <br /> v <br /> Proposed Structure/Addition Use: Z r— li u It <br /> (Home/Cabin;Commercial Business:Bedroom;Deck etc.) �N�Z �^ <br /> Building Contractor:_,. Q C+L l J r Gif Z)11 S V ' l�G T! 1 <br /> o <br /> Anticipated Start Date:__u_�_ ___/- / �Q rg' C <br /> P �- <br /> Pagel01 <br /> 4 Vf� <br /> Burnett County, WI Land Use Application —Rev 4/2015 <br />