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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> F n J <br /> Permit Fees: 5 <br /> Dwelling/Principal Building-Sin le Famil 5300 Addition to Dwelling/Principal Building-Single Family5200 0 u <br /> Dwelling/Principal Building-Multi-Famil S300 Addition[n Dwellin Princi al Buildin -Multi-Family $200 a <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building5200 <br /> O <br /> AccessoryStructure/Addition to Acc.Structure 5150 Bunkhouse 5250 1 <br /> AccessoryStructure-Commercial(C 1&Il) 5200 Addition to Accessory Structure-Commercial(C] &11) 5200 <br /> Dcck/Stairs/Patios 5125 Gazebo(WI Stat 59.692(lv)) 5350 0 <br /> Camping Unit S10o Filling/Grading Sum <br /> r <br /> Permit Extension(Valid for one year-Only 1 Allowed) I $too <br /> *NOTE:Aftcr-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <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 /> 0 <br /> Applicant's Name: -7j8►'• <br /> Applicant's Mailing Address: S70 'fjJ�'"+'y �� ,�oS �,��, , 1j/t/ fs'ejj <br /> /pity State Zip <br /> Applicant's Telephone Number: �p <br /> Applicant's Email: 4%.ryr3 ids- yX t4c( ya foo.cf. � �}} <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v <br /> ❑Letter ®Phone <br /> ❑Email N -Rj <br /> t <br /> Legal Description: �g�// ���'! �ir.ve ' E. -.e <br /> oa <br /> Lot#: - CSM Vol. Pg. OR o 1 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town 4:_Jjj2 N Range#: _W Town of:�- ° �I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* pl 1 01 <br /> Parcel#(24 digits): r <br /> Tax ID#(1-5 digits): r z <br /> d � � <br /> Property Site Address#: a 0 I I <br /> .Road Name: I j City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: LT.GE) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ',Commercial Addition <br /> Ll Stairs LJ Acc. Structure(Non bunkhouse) 13 Bunkhouse LJ Commercial Acc. Structure <br /> R <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit ILCommercial Acc.Addition <br /> Proposed Structure/Addition Use: ✓!/o"t, a✓ �� s w 70 g+Xfsy%�I � <br /> (Home/Cabin;Commercial Business Bedroo�i,�Deck:etc) Q Z Z <br /> Building Contractor: fc l� z <br /> � two <br /> Anticipated Start Date: - 3 /S Z o <br /> Page 1 of 4 " <br /> Burnett County, WI Land Use Application—Rev 4/2015 r--�� <br />