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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> L <br /> `< — It <br /> Permit Fees: o' <br /> 6 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 / n <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 v ) ry <br /> Commercial/Industrial Building $300 Addition to CommerciaWndustrial Building $200 <br /> O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> k/Stairs/Patios $125 Gazebo WI Stat 59.692(ly) $350 l <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 <br /> Permit Extension Valid for one year.-Only 1 Allowed $100 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. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> b <br /> z <br /> / o <br /> Applicant's Name: L Ji ia_ q (/ / <br /> Applicant's Mailing Address: <br /> City State Zip <br /> Applicant's Telephone Number: <br /> c <br /> Applicant's Email: LAI is i,,/ n;G(7 C_S <br /> b <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter [,hone ` ®Email <br /> Legal Description 4:0 N /T e1rJ;k)? V D t,�95P <br /> Lot#: 4 t CSM Vol. Pg. OR U. <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town# N Range#: W Town of. �a2 �(� ✓1 <br /> *Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> l <br /> Parcel #(24 digits): <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 2 F <br /> Road Name: l) ✓✓h /. JQ City <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I jo( <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling LJFilling/Grading LJ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family AdditionR'Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs E3 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse D Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition (� <br /> C <br /> Proposed Structure/Addition Use: q r d <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) Z C <br /> Building Contractor: cert <br /> Anticipated Start Date: o <br /> Page 1 of 4 C <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br />