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LAND USE PERMIT APPLICATION- Burnett County, WI a _ b <br /> y ^ I <br /> Permit Fees: 7 r a <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G �j <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Mufti-Fatrffly Mufti-Fate $200 ' jr, <br /> /�'rl <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 a <br /> Accessory Structure-Commercial C 1 &Il $200 Addition to Accessory Structure-Commercial Cl &11) $200 HE <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c � <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Orfly 1 Allowed $100 N" <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w b <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. LI <br /> rn <br /> Applicant Complete All Sections Below This Line <br /> � � fl, z <br /> Applicant's Name: � �U G,` <br /> Applicant's Mailing Address: or- <br /> -� City State zip b <br /> SApplicant's Telephone Number: LI /� / <br /> Applicant's Email: n O � �J )D[ K, V O `,00 L C, <br /> � w <br /> iDSO <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone ElEmail N b JU <br /> Legal Description:, GS n Liv ���Cy ,J!'c 3f /7'!� /S 1 <br /> Lot#:�_CSM Vol. g. OR <br /> Lot#: Block#: Subdivision Name: OR rn <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: � _N Range#: /,S W Town of: ✓ ',S 0✓1 <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): <br /> C7 <br /> Tax ED#(1-5 digits): <br /> Property Site Address#: �✓ - �J ^ G(Y-1Road Name:zz r,� O A/ �is 1 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: a5 C0 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> f(Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 0 <br /> n W <br /> Proposed la C <br /> osed Structure/Addition Use: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z -� <br /> ;�-%4M <br /> Building Contractor: <br /> c� <br /> n v � <br /> Anticipated Start Date: Q <br /> Page 1 of 4 C �U- <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> M <br />