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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> y ~ 1 <br /> Vi �1 <br /> Permit Fees: tIt <br /> DwellingjPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 $Lti <br /> DwellingnNincipal Building-Mufti-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory StructurelAddition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &I1 $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 1 <br /> Camping Unit $100 Filling/Grading $150LR <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. v <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 /> �o <br /> o <br /> •� 0 <br /> Applicant's Name: //Zp/yrX� p%Y/2-1 �.(�essC��7s Z�® <br /> Applicant's Mailing Address: JV A ? � � <br /> City ` State Zip v <br /> PPTelephone <br /> Applicant's Num er: <br /> Applicant's Email: /2/lU r`'-U.C7� <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ZPhone mail 1 <br /> 0 <br /> Legal Description: — G <br /> Lot#: f CSM Vol k-�l Pg.,&j <br /> Lot#: Block#: Subdivision Name: OR U <br /> Gov't Lot#: o2 OR 1/4 1/4 o I <br /> Section#:—/? Town N Range#: W Town of: <br /> 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): / �J 0 � z <br /> I <br /> Property Site Address#: <br /> Road Name: A6;10Z_ City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Red m= <br /> E 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 59.6922((ly) 71 Camping Unit ❑ Commercial Acc. Addition <br /> Proposed Structure/Addition Use: / o, <br /> (H <br /> j8melCabm;Commercial Bus Hess;Bedroo+ eckr etc) C ✓- <br /> Building Contractor: Z ` �{ <br /> Z � <br /> Anticipated Start Date: <br /> P � <br /> Page 1 of 4 M <br /> Burnett County,W1 Land Use Application—Rev 4/2015 <br /> t� <br />