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LAND USE PERMIT APPLICATION — Burnett County, WI a _ b <br /> Permit Fees: t!' <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 a G <br /> Dwellin Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 W <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 I <br /> m <br /> AccessoryStructure-Commercial Cl &11) $200 Addition to AccessoryStructure-Commercial Cl &II) $200 ' <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $150 1 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '— <br /> d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. 2 <br /> �u <br /> m <br /> Applicant <br /> Complete All Sections Below This Line _ <br /> Zjv l✓1 �1<✓Z t2fJ �� Z <br /> o <br /> Applicant's Name: C� �^ <br /> Applicant's Mailing Address: c7 ZZ� D o <br /> $t�tel Zip <br /> Applicant's Telephone umb �4 o y �y <br /> Applicant's Email: �f� dZr Pe <br /> w <br /> iD <br /> If staff has a question about this application how do you preferbe contacted? Check one below. <br /> ❑Letter hgtte/ mail _ oI�N °C <br /> Legal Description: W 1 47:- �' C5A4 UL1 ` 7 6) G`GV ��� 2.17) - <br /> Lot#:Z,CSM Vol.V_Pg. 0j OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> L <br /> 5/ <br /> Section#:��Town#:�N Range#: 1. 9 W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tar system property Page.* ti <br /> Parcel#(24 digits): <br /> -o4-Z,- z-36 -1 (2) -3(,-5- '�G�'dSj <br /> Q ,�{{ z <br /> Tax ID#(1-5 digits): 7i ! `t'�� y X <br /> H <br /> Property Site Address#: <br /> Road Name: kok-4 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:j-kZ„(D <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building E <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs )i"Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> Proposed Structure/Addition Use: N m <br /> r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z Z--I) bZ O <br /> Building Contractor: /��Z� { Z, O <br /> L) <br /> Anticipated Start Date: tt�'✓ C cr u u u <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> e <br /> x <br /> m <br /> a <br /> m <br />