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LAND USE PERNHT APPLICATION — Burnett County, WI <br />Permit Fees: <br />❑ Commercial Building <br />';rDeck/Patio <br />Dwelling/Principal Building - Single Family <br />$300 Addition to Dwelling/Principal Building - Single Family <br />$200 <br />DwellingtPrincipal Building - Multi -Family <br />$300 Addition to Dwelling/Principal Building - Multi -Family <br />$200 <br />Commercial/Industrial Building <br />$300 Addition to Commercial/Industrial Building <br />$200 <br />Accessory Structure/Addition to Acc. Structure <br />$150 Bunkhouse <br />$250 <br />Accessory Structure -Commercial Cl & Il <br />$200 Addition to Accessory Structure -Commercial (Cl & II) <br />$200 <br />Deck/Stairs/Patios <br />$125 Gazebo (WI Stat 59.692(Iv)) <br />$350 <br />Camping Unit <br />$100 Filling/Grading <br />$150 <br />Permit Extension (Valid for one year - Only 1 Allowed) <br />$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. <br />Applicant Complete All Sections Below This Line <br />Applicant's Name: I A`'�-- <br />Applicant's Mailing Address: <br />City StateZIP <br />Applicant's Telephone Number:_ -M 1 /" <br />Applicant's Email: I ()& Vq <br />If staff has a question about this application how do you prefer to be contacted? Check one below. <br />❑Letter ❑Phone?,Mail <br />Legal Description: <br />Lot #: CSM Vol. Pg. OR <br />Lot #: Block #: Subdivision Name: OR <br />Gov't Lot #: OR 1/4 1/4 <br />Section #: ?a[ Town #: 91 N Range #:_%---W Town o£ 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): ®�' <br />Tax ID # (1-5 digits): ILL <br />Property Site Address #: 177? <br />Road Name: L@(. LM b[� Z _ _ City: 6 pi tzT�s <br />TYPE OF PERMIT(S): Check appropriate box/boxes <br />)WV5ingle Family Dwelling ❑ Multi -Family Dwelling <br />❑ Single Family Addition ❑ Multi -Family Addition <br />.1r-5tairs ❑ Acc. Structure (Non -bunkhouse) <br />❑ Permit Extension ❑ Gazebo - WI Stat 59.692(ly) <br />Proposed Structure/Addition Use: <br />Building Contractor: <br />Anticipated Start <br />(Home/Cabin; <br />❑ Filling/Grading <br />❑ Commercial Building <br />';rDeck/Patio <br />❑ Commercial Addition <br />❑ Bunkhouse <br />❑ Commercial Acc. Structure <br />❑ Camping Unit <br />❑ Commercial Acc. Addition <br />Bedroom; Dick; etc.) <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2016 <br />Fee Rec: f l <br />x <br />y <br />0 <br />m <br />°z <br />�Z <br />� <br />cra <br />® <br />0Z <br />v� <br />0 <br />a <br />m <br />m <br />