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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> 6 ? <br /> m � V <br /> Permit Fees: ut <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <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 &Il) $200 Addition to Accessory Structure-Commercial CI &Il) $200 i:7 9j <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 c 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> o <br /> Permit Extension Valid for one year-Only l Allowed) $100 — <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. = <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. q <br /> 'v <br /> Applicant Complete All Sections Below This Line o <br /> z <br /> Applicant's Name: y <br /> Applicant's Mailing Address:_/P/ k.,)Z <br /> City State Zipf <br /> �7 z <br /> Applicant's Telephone Number: //S 2( � - zZ s/_ o_ <br /> Applicant's Email: V 4„ j_2 L2V <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> v <br /> ❑Letter Phone ❑Email °G I <br /> Legal Description: ' t <br /> Lot#:��_CSM Vol." V Q P9.�_ OR <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#; OR / 4 _I/4 x.'1.2 Ify'Z o <br /> Section#: Town#: _N Range#: _W Town of: T�¢sso <br /> 1 a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y 1 1 <br /> Parcel#(24 digits): C> 7-- 3 1) 9 <br /> Tax ID#(1-5 digits): <br /> N <br /> Property Site Address#:� <br /> Road Name: 127 ACC-2 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:)W, <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) 1$Camping Unit ❑ Commercial Acc. Addition <br /> /� 1 nFriR <br /> Proposed Structure/Addition Use: .200S_ /QpG/w. LfJOGW ,�(�n .Z.�~ , Z D <br /> (Home/Cabi ommercial 11—usiness;Bedroom;Deck:etc.) <br /> Building Contractor: w U <br /> c= <br /> Anticipated Start Date: m v' <br /> < GZtU <br /> Page 1 of 4 c <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 9 <br /> S <br /> m <br /> A <br /> I <br />