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LAND USE PERMIT APPLICATION — Burnett County WI r <br /> a 3 el" <br /> Permit Fees: <br /> 1 <br /> Dwelling/Principal Building-Sin le Family <br /> $300 Addition to Dwelling/Principal rind al Buildin -Sin le Family $200 �7 O <br /> Dwellin 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 _ 0 <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial Cl&Il) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo WI Stat 59.692(lv)) $350 o <br /> Camping Unit $100 Filling/Grading $150 <' } <br /> Permit Extension Valid for one year-Only I Allowed) $100 o 1 <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 /> �a <br /> m <br /> Applicant Complete All Sections Below This Line r <br /> 0 <br /> � z <br /> S r <br /> Applicant's Name:, e 1.I�i c�L I�+�✓• ( <!'i/nw .r <br /> Applicant's Mailing Address: 2y 3 Z tom h_ ��,re Q Y t-b)0_, M ri 3y <br /> City State zip <br /> 3 <br /> Applicant's Telephone Number: 5 07 <br /> — Z'3 <br /> c C> <br /> rn <br /> Applicant's Email: _5 of rt J 2_`Y �/a iti vv• C Fs�-. " t <br /> 0 <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> c t <br /> ❑Letter 'hone ❑Email N r <br /> Legal Description: PC L CgvJ L v 9 -8 — ► ► —Qf y � <br /> Lot#: CSM Vol. 43 Pg. OR <br /> N <br /> n <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 F <br /> 1 IBJ <br /> Section#: Town#: N Range#: W Town of: 4c,.-}f � 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 /> } <br /> Parcel#(24 digits): o <br /> z <br /> Tax ID#(1-5 digits): w � <br /> Property Site Address#: I po8 y <br /> Road Name: <br /> Sc. KcS &CA city: $poo Ke.✓' <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:ISO <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 'o <br /> ❑ Stairs >(Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit E=xtension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> n <br /> Proposed Structure/Addition Use: Me— `� PSS o itrvf 14-S e <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: S L <br /> °z <br /> a <br /> Anticipated Start Date:_ <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> m <br /> fn <br />