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LAND USE PERMIT APPLICATION— Burnett County. WI a ro <br /> y. 1 <br /> Permit Fees: ; to <br /> a <br /> Dwellin rinci al Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al 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 CI &11) $200 Addition to Accessory Structure-Commercial Cl &11) $200 <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-Onl IAllowed) $100 o <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 stnrctures,such as:pergolas, landscaping, retaining walls. q <br /> v <br /> Applicant Complete All Sections Below This Line a <br /> y z <br /> Applicant's Name: 7 t Vj'- -j- k4•pn If e4 / I c` o <br /> Applicant's Mailing Address: I(J p UQ Q l t-I-t wQ ,},lt aQ (,l, (z Z <br /> f ity State zip <br /> �— <br /> PP P lUSI - TJ `f - O <9Z z <br /> Applicant's Telephone Number: C/ ` o H d <br /> c <br /> / c. <br /> Applicant's Email: Q('1 V\!S4,e j eQ tYIO l I . Co rK 1 d <br /> 1 d <br /> If staff'has a question about this application how do u prefer to be contacted? Check one below. <br /> ❑Letter hone ❑Email N <br /> t <br /> Legal Description: g1 <br /> o� <br /> Lot#: Q CSM Vol. _P9. O '? OR d <br /> Lot#: Block#: Subdivision NI ame: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#:� Town#: Q N Range#:::LW Town of SC 4 ( I <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): r <br /> w <br /> 7' <br /> m <br /> Tax ID#(1-5 digits): yz <br /> )p2 ( r N <br /> Property Site Address#: <br /> Road Name: n h P j� City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:Lsvzo <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ StairsAcc. Structure(Non-bunkhouse) El Bunkhouse ❑ Commercial Acc. Structure � <br /> Ll Permit Extension /❑\Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition Z C <br /> �3'1 L � Z C <br /> Proposed Structure/Addition Use: y �- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) r— (^� <br /> Building Contractor: <br /> 0 <br /> N <br /> Anticipated Start Date: m Z o <br /> Page 10 4 c <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 9 <br /> S <br /> M <br /> m <br />