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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> a b <br /> a <br /> y N <br /> Permit Fees: r �. <br /> DwellingtNncipal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 <br /> d <br /> ellin rinci al Building-Multi-Famil 00 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaWndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 lv $350 c <br /> Camping Unit 1 $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 /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. f <br /> v <br /> Applicant Complete All Sections Below This Line ; . <br /> Applicant's Name: 4/C 117 (, / //4Ln Mailing Address: �S—�U ' , �� �Ns�/�!J GtIT 5`-S�3// 004 <br /> City State zip rte„ ON <br /> Applicant's Telephone Number: 9 r4,) -rl�- 7 �j�� o d <br /> ,/� a <br /> Applicant's Email: ( )� n b��cr Q#4 a ne.;!� d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> ❑Letter b <br /> /� 1 [-]Phone [Email � � l <br /> al Description: "1 W 6 n -� S%/�voh JV7P�d x'/96T%S PLew, //c <br /> #: CSM Vol. g. 6R <br /> Lot#• Block#: Subdivision Name: OR rn <br /> Gov't Lot#: OR 1/4 U/r 1/4S Pc-b,'-' <br /> r,'-' o <br /> Section#: 7 Town#:�t N Range#: _W Town of: AJC 2t J� i <br /> *Attach additional page ifneededror lengthy description OR attach a copy of the deed OR attach tax system propertyPa8e.* y <br /> Parcel#(24 digits): --O�g- — o -/�'-�� 3' ©s'—ao-� —elaWeo a <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: <br /> Road Name: <br /> 7PE OF PERMIT(S): Check appropriate box/boxes Fee Rec:3(X1f� <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition g C <br /> n <br /> Proposed Structure/Addition Use: Eli llei O <br /> (Home/Cabin;Commercial Business;Bedroom,;Decketc.) NZ <br /> iilding Contractor: fc <br /> _ <br /> 1-U <br /> r4411 0 <br /> �Aicipated Start Date: � y , ,�Q�� IAO Q o <br /> Page 1 of 4 o Z ltl] <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> x <br /> M <br /> a <br /> m <br />