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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> b <br /> tn' <br /> N Ni <br /> Permit Fees: ; o <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin rinci al Building-Sinle Family $200 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 I n m JI��J—J1 <br /> Commercial/Industrial Buildin $3 Addition to Commercial/Industrial Buildin $200 V 1 p <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 ` o <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/StairstPatios $125 Gazebo WI Stat59.692(lv)) 1 $350 n I <br /> 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $loo <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a <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. 1e <br /> ro <br /> Applicant Complete All Sections Below This Line <br /> 0 <br /> Applicant's Name:GDLcA41� 30M N I� L'ut A13U S30M N � L'ut A 3U S <br /> Applicant's Mailing Address: /o osc L-o /w,4, <br /> JN <br /> City State zip rA <br /> ` z <br /> Applicant's Telephone Number: (p S f-7 S�'-{2 2 Z c N # <br /> n - n - <br /> Applicant's Email: E Coy vM f3ij CD • C_c> q p <br /> w <br /> iD <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letterhone ❑Email N <br /> w <br /> Legal Description: E. <br /> Lot#: 3 CSM Vol.-Pg. 7t OR d <br /> Lot#: Block#: Subdivision Name: OR t <br /> y <br /> Gov't Lot#: OR 1/4 1/4 £ 1 <br /> Section#: Town#: N Range#: W Town of.. SCOTT I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Parcel#(24 digits): l7 - t7e "��T U _/4-bq -3 03-000- 013 CO-D � <br /> Tax ID#(1-5 digits): 1 -Moo' <br /> z <br /> Property Site Address#: r� n <br /> Road Name: L of 1 l Ah« 2DPc0 City: DA8t, <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building P <br /> ❑ Single Family Addition Ll Multi-Family Addition ❑ Deck/Patio Ll Commercial Addition l <br /> ❑ Stairs WoAcc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) aCamping Unit ❑ Commercial Acc. Addition CD <br /> n C <br /> Proposed Structure/Addition Use: SGZaC-A, AD&W Z <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) M n <br /> Building Contractor: Q <br /> 0 _ �• <br /> Anticipated Start Date: m C o <br /> Page 1 of 4 o Z �U <br /> Burnett County, WI Land Use Application—Rev 1/2016 <br />