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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> y <br /> Permit Fees: <br /> ^ 0. <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 1 <br /> DwellinglPrincipal Building-Multi-Famity $300 Addition to DwellityRrincipal Building-Multi-Family $200 0 <br /> Commercial/Industrial Build $300 Addition to Commercial4ndustrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Accessory Structure or Bunkhouse 5250I <br /> Accessory Structure-Commercial CI&Il 5200 Addition to Acces Structure-Commercial CI&Il 5200 1c <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(1v)) $350 c I <br /> Camping Unit $100 I Fillip Grad $150 <br /> Permit Extension Valid for one year-Only I Allowed Sim <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the aormal fee. rn <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. T <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> ro <br /> Applicant Complete All Sections Below This Line or . <br /> Y ern <br /> vv�b • z <br /> Applicant's Name: e_ <br /> Applicant's Mailing Address: (� <br /> PP g ZHU (? w�C�v�1C Ut�wl� nD�vlW CD4 1 <br /> City State Zip r) ro <br /> Applicant's Telephone Number: <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. y `I <br /> ❑LetterPhone QEmail ro <br /> Legal Description: a <br /> Lot#: CSM Vol. Pg. OR g J <br /> �+ Sinn 1 <br /> Lot#: � Block#: Subdivision Name: _ OR � y <br /> Gov't Lot#: OR 1/4 1/4 o (} <br /> li <br /> Section#: Town N Range#: �W Town of1i3' ,r- <br /> Aaach addtional age i neededfor lengthy description OR attach a copy o the deed OR attach tax <br /> t� system property page.* <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): (�� z <br /> Property Site Address 4:� � O� , <br /> A \ <br /> Road Name: Ll1j\fj City: �s'i Moe ` <br /> TYPE OF PERMrr(S): Check appropriate box/boxes Fee Rec:20-2c ip 'U <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building 9 <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 0 <br /> � 1 ( k <br /> Proposed Structure/Addition Use: 5 v M <br /> Wome/Cabin;Commercial Business;Bqmm,Deck,etc.) Z --a <br /> � <br /> Building Contractor: lSy r'[lSL1Lp1 LiY% <br /> R0 <br /> 11 �1 K t.� <br /> cd <br /> t <br /> Anticipated Start Date: 1^�15 J V I n_V Is p <br /> Page I of 4 Z [� <br /> Burnett County,WI Land Use Application—Rev 3/2015 Z <br /> m <br />