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LAND USE PERMIT APPLICATION —Burnett County, ��'I F r <br /> (� V <br /> Permit Fees: 0, I (T% <br /> a ` <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 <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 ' w O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 t <br /> Accessory Structure-Commercial(Cl &I l) $200 Addition to Accessory Structure-Commercial C 1 &I l) $200 �1 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only1 Allowed $100 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. <br /> Applicant Complete All Sections Below This Line . (T, <br /> z <br /> Applicant's Name: L � �,�A-\„A UN a <br /> Applicant's Mailing Address: S `] rJ a r, S (2 <br /> City State zip o <br /> Applicant's Telephone Number: o f <br /> a <br /> Applicant's Email: v <br /> w <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email °G <br /> 0 <br /> Legal Description: P r / 5' .E S f t <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR 41 <br /> Gov't Lot#: OR 1/4 1/4 0 1 <br /> Section#:13 Town#:-T—N Range#: W Town of. r, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* -j <br /> Parcel#(24 digits):U'7 o J G3 - 1d 17 n <br /> z <br /> Tax ID#(1-5 digits): z; y <br /> Property Site Address <br /> `� J <br /> Road Name:JAG ,S s L }( e City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> n Z <br /> Proposed Structure/Addition Use: 4 m � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M <br /> tQ <br /> Building Contractor: (° Q�a� - <br /> afl <br /> p c `' <br /> Anticipated Start Date: m C rn <br /> Page 1 of 4 o Z <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> a <br /> m <br />