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LAND USE PERMIT APPLICATION - Burnett County WI a ro <br /> Permit Fees: 0w r+ <br /> DwellingPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 +` N <br /> Dwelling/Principal 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 O <br /> Accessory Structure-Commercial(C I &11) $200 Addition to Accessory Structure-Commercial Cl &I l) $200 y� <br /> Deck/Stairs/Patios $125 1 Gazebo(Wl Stat 59.692(l v)) $350 O 11)J <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <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. Z <br /> Applicant Complete All Sections Below This Line r �. <br /> o <br /> —J' { z <br /> Applicant's Name: ✓ d/� /� C(/CL j�i17U l� ,A <br /> Applicant's Mailing Address: .7 7C y7 /Fa/'�t C( 0-6'k/�'D/y1��7��/t`KV, ,! <br /> City State_ Zip — <br /> PP P �S L�C Z L�y SSd9Z o y z <br /> Applicant's Telephone Number: Z ti <br /> Applicant's Email:��Gr etL�t?y1 C �l o A:± e r /t ci� <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> [—]Letter Phone Email <br /> w° <br /> o � <br /> UQ r,' 1 <br /> Legal Description: UQ �C/ <br /> Lot#: CSM Vol. Pg. OR q <br /> n <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR � <br /> Gov't Lot#: OR 1/4 1/4 o <br /> a <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* H <br /> Parcel#(24 digits): � <br /> Tax ID#(1-5 digits): z <br /> Property Site Add ess#: �(v� <br /> Road Name:_ l'C5 City:; <br /> TYPE OF PERMri(S): Check appropriate box/boxes Fee Rec: /So* d <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio <br /> Ll Commercial Addition y <br /> 0 <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> L3Permit Extension E3Gazebo—WI Stat 59.692(iv) LlCamping Unit L3Commercial Acc.Addition z <br /> OD <br /> —z Q <br /> !y n <br /> Proposed Structure/Addition Use: d rw / e a C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,", M <br /> �o r7`h/t-�.� ,l3cG� /Q/.� , z <br /> Building Contractor: ry � <br /> Q <br /> Anticipated Start Date: Z o <br /> Page 1 of 4 f? I7 C o ciig <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> m <br />