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LAND USE PERMIT APPLICATION -Burnett County, WI Crcn <br /> Permit Fees: <br /> a ` <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 \ <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to Dwellin Princi al Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 t <br /> I <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 <br /> < 3 <br /> Camping Unit $100 Filling/Grading $150 .. <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed $loo �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 er � <br /> Z D. <br /> Applicant's Name: f e <br /> � o <br /> Applicant's Mailing Address: 90k3 7 _ L o c�,PMNA�omAx tel- • k000 l <br /> City State Zip W b <br /> Applicant's Telephone Number: �yn� - 3-7 9-6 1 kas` o <br /> Applicant's Email: IN M, l v A OL- I <br /> w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Lette`r ` Ph e ❑Email tl0 <br /> Legal Description: 5e— C_ 2. <br /> Lot#: CSM Vol. Pg. OR v <br /> N <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 f t <br /> 0 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* (V`�r► � <br /> Parcel#(24 digits): <br /> z $ <br /> Tax ID#(1-5 digits): x1 <br /> Nr <br /> Property Site Address#: a 8 ❑g y <br /> Road Name: City:U \m\tZ wa. alert <br /> F <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 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure °m <br /> EIPermit Extension LlGazebo-WI Stat 59.692(ly) LlCamping Unit ElCommercial Acc.Addition °5 C <br /> Proposed Structure/Addition Use: J CG1 f G�(c-tet,p IN�c�\n ')-3--c D y <br /> D ^�J <br /> (Home/Cabin;CoMme`rcial Business;Bedroom;De •etc.) � <br /> Building Contractor: 0 !J t! l! <br /> o <br /> Anticipated Start Date: m C <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application -Rev 4/2015 <br /> 9 <br /> 2 <br /> m <br /> z <br /> m <br />