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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwell in Princi al Building-Multi-Family $200 SO <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &II $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> `R <br /> Deck/Stairs/Pados 1 $125 1 Gazebo WI Stat 59.692(l v)) 1 $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. w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> ;v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. 2 <br /> ro <br /> Applicant Complete All Sections Below This Line . <br /> Applicant's Name: 1!�rJ4 L 9A) Q\w <br /> Applicant's Mailing Address: 2 <br /> State Zip ro <br /> Applicant's Telephone Number: //c-V '—e?Zd o <br /> ) ��J� , , 5 3� <br /> /Jc z <br /> Applicant's Email: MAA 7C/4T/P�Tfl�/¢T C��n rl�(I"l G��!9 1 d <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letterhone EmailZL <br /> o °` <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. O ° I <br /> S. <br /> Lot#: Block#: Subdivision Name: OR m <br /> Gov't Lot#: OR 1/4 1/4 J £ t <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if neededfor lengthy description OR at ch a copy of the deed OR attach tax system propertyPage.* -i <br /> S L, <br /> Parcel#(24 digits): <br /> f / � <br /> Tax ID#(1-5 digits): J <br /> Property Site Address#:31 O 6 N <br /> (n <br /> Road Name: �� nt- V1 City: <br /> E OF PERMIT(S): Check appropriate box/boxes Fee Rec:� <br /> TYPE <br /> Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> h <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 'o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m Q <br /> ❑ Permit Extension Ll Gazebo—WI Stat 59.692(ly) El Camping Unit ❑ Commercial Acc. Addition <br /> 1 <br /> Proposed Structure/Addition Use: ice, <br /> (Home/Cabin;Commercial. ess;Bedroom;De( -tc.) t <br /> Building Contractor: <br /> Anticipated Start Date: <br /> Page 1 4 -�-I <br /> Burnett County, WI Land Use Application-Rev 4/200 15 <br /> m <br /> m <br />