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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingtPrincipal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 w, <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 V 1 <br /> Accessory Structure-Commercial C1 &11 $200 Addition to Accessory Structure-Commercial(Cl &11 $200 <br /> Deck/Stairs/Patios $125 Gazebo Wl Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year-Only I 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 and fees. ° <br /> *Items not listed above will be treated as accessory structures,such as.pergolas, landscaping,retaining walls, <br /> ro <br /> m <br /> )� �n / z <br /> Applicant's Name:���f7 Y '/ SC k4 i/- e✓12 <br /> Applicant's Mailing Address: e�W9 1 P��L <br /> / l �/\ City State Zip b <br /> Applicant's Telephone Number:/'I/ y 6 7 c c '� <br /> Applicant's Email: Z4,k,15c)A a3 t(3 � No-7-mA-:C-L C oAi d <br /> m <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> w I <br /> ,p� ❑Letter (Phone ❑Email `; <br /> Legal Description: / �L GO✓ LOT tf o JCSM!✓T3S7G73� o' <br /> w i <br /> Lot#: CSM Vol. Pg. OR r <br /> a. I <br /> Lot#: Block#: Subdivision Name: OR = „ <br /> Gov't Lot#: y OR 1/4 1/4 <br /> Section#: Town#:_1y0 N Range#- R l7 W Town of: 110A ) 1 <br /> *Attach additional page if needed for lengthy description OR attach a ropy of the deed OR attach tax system propertypage. <br /> 1 <br /> Parcel#(24 digits): 07 - 0.310qc) -/ 7 -13 66' 00� - 0-:;�1000 <br /> x <br /> Tax ID#(1-5 digits): q6 7� <br /> Property Site Address#: / <br /> Road Name: de171 Z_ SS L.14 k L City: .04A1o u ,5?K C 30 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes ]V <br /> Fee Rec:� e <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 <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> r�Xtrf�a� <br /> Proposed Structure/Addition Use: 3 5��5 oj1J PoKCP - C 14 Jl n/- leelomGt; DEG k <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �A m D <br /> Building Contractor: N .¢ <br /> J <br /> Anticipated Start Date: <br /> Page 1 of 4 CUI <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />