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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Permit Fees: th <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 v J <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 _ <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1 &Il) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 J <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 0 <br /> <, <br /> Camping Unit $100 Filling/Grading $150 � �{ <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 ° <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. '� 1 <br /> w <br /> *Items not listed above will be treated as accessory structures,such as pergolas, landscaping, retaining walls. 2 <br /> y <br /> r � ` <br /> o <br /> 0 <br /> Applicant's Name: <br /> Applicant's Mailing Address: /6 0 r� �V I,^4jxj sT N LV AIV DL)J e /J SS�et� <br /> City State Zip = <br /> PPTelephone <br /> Applicant's s Number: <br /> ICS stir a <br /> Applicant's Email: � � /�1 L fin" d <br /> i9 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter 2110hone ❑Email o <br /> a <br /> Legal Description: <br /> Lot CSM VoLa__Pg. .14,9 OR <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 I a <br /> Section Town#:_L4 0 N Range#:__LL__W Town of: <br /> *Attach additional a e i needed or lengthy descri tion OR attach a co o the deed OR attach tax stem ro er a e.* VV <br /> P 8 .f .f P Py' f s7' P P 4'P 8 J <br /> Parcel#(24 digits): - 4C) - i - 0 7 - y b 2—G�b -015 - 3 <br /> o- <br /> 1 C.11>p n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: oZ 6`1 ! b <br /> Road Name: A)Vj' y�jjow R11� lOti, City: EX��1� ✓ � <br /> r � <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rea <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition JM'6eck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 5911.692(ly) ❑Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: R"o i ) J Q Gt t7 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) Z M <br /> Building Contractor: lJV <br /> Anticipated Start Date: G) <br /> Page 1 of 4 Znrl' <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />