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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> N ~' <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 O Q <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building 00 Addition to CommerciaVlndustrial Building $200 — o <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 \ <br /> Accessory Structure-Commercial C I &11) $200 Addition to Accessory Structure-Commercial C 1 &11) $200 a- <br /> Deck/Stairs/Patios $125 1 Gazebo WI Stat 59.692(l v)) $350 0 <br /> Camping Unit $100 Fillin Gradin $150 <br /> r <br /> Permit Extension Valid for one year-Only I 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 /> d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. 2 <br /> 'o <br /> Applicant Complete All Sections Below This Line <br /> ' {� z <br /> Applicant's Name: f g-n p r�7 K t1 1� /� 1�r V q e <br /> 1. ✓ 1 ) .�/,� <br /> Applicant's Mailing Address: rpt / [) 02 oV�/�lf R d Ad 5�J`YW_ I 7 S61 <br /> Cityr State zip <br /> / Q 8 z <br /> Applicant's Telephone Number: -7 1 S^ to 35- 7 6 <br /> Applicant's Email: F�a(� �� R p� �j �TAl�q icomp <br /> >v <br /> iD <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ) <br /> b t <br /> `I ❑Letter Phone &mail L <br /> Legal Description: .5 w - N£ �- S - &4) Sec T 3 Iq //y R A7 al �' I <br /> Lot#: CSM Vol. Pg. OR o <br /> N <br /> n <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: lQ ' <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* Y <br /> V' <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): 260 ❑ z <br /> Property Site Address#: <br /> Road Name: ��� City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: .0c) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure � <br /> N C ✓v <br /> ❑ Permit Extension El Gazebo-WI Stat 59.692(ly) El Camping Unit El Commercial Acc. Addition z <br /> nn <br /> Z C <br /> Proposed Structure/Addition Use: Add / G t Te ivo t—,1 Ih ewc) d f oi YS•X 32 )/l0t/ Y-4* � � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 U <br /> �At <br /> I > n Cv� <br /> Building Contractor: APPev Ay:�dl" 7Jm CFd' �t"C-k 0 ^' <br /> C=) <br /> Anticipated Start Date: /QvA d , 201 m Z llfl <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> b <br /> x <br /> m <br />