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LAND USE PERMIT APPLICATION —Burnett County, WI d <br /> �' Mr <br /> Permit Fees: a <br /> DwellingjPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family $200 , <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 I <br /> Accessory Structure-Commercial(Cl&I I $200 Addition to Accessory Structure-Commercial CI&Il $200 <br /> Deck/Stairs/Patios 59.692 lv $350 <br /> Cam in Unit $100 GWdSa150 °e <br /> 1 O <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed $100 a <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 /> Applicant Complete All Sections <br /> Applicant's Name: 4SKa elow This Line c . <br /> Od /6 (�'J y 74 kI UWS4 <br /> xxm, <br /> (( C <br /> Applicant's Mailing Address: ,I� V — �� J7 <br /> Wf� City�7 State Zip b <br /> Applicant's Telephone Number: 2l5-"! ��� / <br /> � <br /> ���/ V�� s`3 „ <br /> Applicant's Email: M �{Aff 7� ® �r/Il <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter UPhone ❑Email N °0 t <br /> Legal Description: <br /> S-e e 141 efiix.. *,/ <br /> Lot#:�_CSM Vol. U UP Pg OR d <br /> 5. 1 <br /> Lot#: Block#: Subdivision Name: OR 0r„ <br /> Gov't Lot#: OR 1/4 1/4 C7,0 <br /> Section#: Town#: N Range#: W Town of. SCO 170L- 20` O1 <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): 62 - 0 2 - Z <br /> -6 29 z a <br /> Tax ID#(1-5 digits): / 9 <br /> Property Site Ad s#: y <br /> Road Name: 171�/Sil�/J / City: 00 iJQ r <br /> F <br /> TYPF,OF PERMIT(S): Check appropriate box/boxes Fee Rec:. <br /> Single Family Dwelling Multi-Family Dwelling Filling/Grading Commercial Building E5 <br /> Vi <br /> - Single Family Addition 2 Multi Family Addition Deck/Patio -. Commercial Addition <br /> Stairs Acc. Structure(Non-bunkhouse) Bunkhouse Commercial Acc.Structure " <br /> N <br /> -1 Permit Extension Gazebo-WI Stat 59.692(ly) Camping Unit Commercial Acc.Addition <br /> � C <br /> Proposed Structure/Addition Use: aw, Z C <br /> (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) r <br /> Building Contractor: / f' o U41" <br /> L /• n <br /> Anticipated Start DateAuf / D T c 0 0 <br /> Z <br /> Page 1 of 4 c <br /> [r1nJ <br /> Burnett County,WI Land Use Application —Rev 4/2015 <br />