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LAND USE PERMIT APPLICATION - Burnett County, WI a _ b <br /> N ^ <br /> Permit Fees: $ to <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 b <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 n1 <br /> Commercialllndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial (CI &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 r <br /> V ° CD <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessoty structures,such as:pergolas, landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> �41�/1r 6 Brie^) z <br /> Applicant's Name: t— c // ) <br /> Applicant's Mailing Address: 7 J ©�k_ 5� A t� !SoA) ,tet t D/6 <br /> City State Zip b <br /> (oloZ- l — z <br /> Applicant's Telephone Number: ? 9 7710 <br /> Applicant's Email: © c e L e u R S T <br /> 4P— <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> t . <br /> Letter ❑Phone ❑Email N vJ <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#:--7Z Block#: Subdivision Name:J4 rh i-e_ L,4-pe OR v, <br /> Gov't Lot#: OR-1/4 1/4 <br /> Section#: Town#: N Range#: W Town of <br /> *Attach additional page if neededror lengthy description OR attach a copy of the deed OR attach tar system property page.* s v <br /> d <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): 371)3 a <br /> Property Site Address <br /> I#: <br /> 23 <br /> Road Name: Sre- L�;"­i Pi City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes F e Rec: 01 cD <br /> ❑ Single Family Dwelling L3 Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building o �4 <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition �–tJ <br /> 'Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc. Addition z <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) Z CD <br /> 5 e L. C� <br /> Building Contractor: F -M <br /> r-1 <br /> v9 oZ <br /> Anticipated Start Date: 0 c� <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> m <br /> A <br /> m <br />