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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family 5300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellinrinci al Buildin -Multi-Famih $300 Addition to Dwellin rinci al Building-Multi-Family 5200 <br /> Commercial/Industrial Building S300 Addition to Commercial/Industrial Building $200 v <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 I <br /> Accessory Structure-Commercial(Cl&Il) 5200 Addition to Accessory Structure-Commercial(Cl&Il) $200 tJ I <br /> 0 <br /> Deck/Stairs/Patios 5125 Gazebo(WI Stat 59.692(ly) $350 oc 1 <br /> Camping Unit 5100 Filling/Grading $150 <br /> r <br /> Permit Extension(Valid for one year-Only 1 Allowed) SI00 ° <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 occessory structures,such as:pergolas,lamheo in ,retaining walls. <br /> ro <br /> rlppiicaxt.Cµ P.�;tSsQ#k tion Y i r <br /> 0 <br /> z <br /> 0 <br /> Applicant's Name: <br /> Applicant's Mailing Address: ra?3 <br /> City State Zip b <br /> Applicant's Telephone Number: ' Pes�"/� -�— 4-.S�o'� o - <br /> Applicant's Email: <br /> If staff has a question about this application how do you refer to be contacted? Check one below. <br /> �c <br /> ❑Letter honemail o <br /> � l <br /> Legal Description: <br /> Lot#: Z CSM Vol. 4 �0 g."j-g OR C. <br /> Lot#: Block#: Subdivision Name: OR = m <br /> Gov't Lot#: --1- OR 1/4 114 -9j a <br /> & I <br /> Section#: Town#:_,�N Range#:_j���_W Town of: jl A <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 /> Tax ID#(1-5 digits): <br /> x � <br /> Property Site Address#:4.��'/ <br /> Road Name: jCity: <br /> E <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:_Jo� <br /> ❑ Single Family Dwelling El Multi-Family Dwelling 13Filling/Grading L3 Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> (Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> Proposed Structure/Addition Use: l S ! DQ �1 � �7 <br /> (Home.Cabin, Commercial Business,Bedroom,Deck, etc. N Z <br /> ' <br /> Om <br /> Building Contractor: , L�,c ^l>Q�'� i Z <br /> Anticipated Start Date: �.' r.� �7' ` ,—�_ ;._ � bbd 1-r�1e�_ 00 <br /> Page 1 of 4 Z a' <br /> Burnett County,WI Land Use Application-Rev 1/2016 <br />