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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> k � b <br /> v N1 <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � Jj <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> ro <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 p <br /> Accessory Structure-Commercial Cl &II) $200 Addition to Accesso Stntcture-Commercial CI &II) $200 00 <br /> Deck/Stairs/Patios $l25 Stat 59.692 ]v)) $350 <br /> \ <br /> Gazebo WI c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. W <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 <br /> Applicant's Name: /'/ jqG� �� p <br /> Applicant's Mailing Address: ,27208 ��Y es- ll/Lce� r// .���� �Q� <br /> City State Zip rni Q <br /> Applicant's Telephone Number: �SJ- Yoe -/a'/yoo o d <br /> c <br /> Applicant's Email: -77,41, "e-Z-4467 L!' t/"40 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> 1 =- <br /> -]Letter UPhone ❑Email N w 1 1 <br /> Legal Description: a "p, r L <br /> Lot#: CSM Vol. Pg. OR o <br /> m <br /> Er. <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 c <br /> 1 f <br /> Section#: 3:�; Town#:­ '& N Range#:1&—W Town o£ Qq q_ h d/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Parcel#(24 digits): <br /> p� z <br /> Tax ID#(1-5 digits): <br /> Property Site Addresses#: Z+7208 y <br /> Road Name: /7 ►!(Y .-7Jr City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes PO <br /> Fee Re( <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> WS'ingle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition z C <br /> `��� M n <br /> Proposed Structure/Addition Use: ,�xa'r1 > NN m <br /> (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) O Z �+ c �J <br /> Building Contractor: A T® Z dowl✓ ewe-TiON { /Z� o� <br /> YI O <br /> Anticipated Start Date: <br /> _/� <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> z <br /> m <br />