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LAND USE PERMIT APPLICATION -Burnett County, WI r <br /> d <br /> b <br /> N ^ <br /> N �1 <br /> Permit Fees: 0 to <br /> a <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <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 Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 c ' p <br /> < <br /> Camping Unit $100 Filling/Grading $150 C <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <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 /> ro <br /> Applicant Complete All Sections Below This Line G <br /> i� <br /> Applicant's Name: 2L c]. C/ <br /> Applicant's Mailing Address: I <br /> City State Zip W ro <br /> Applicant's Telephone Number: � o y <br /> Applicant's Email: �d)o& .�') yo A 6o GEJ d 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. O <br /> ro U <br /> I I ❑/Letter �/Phone / Email <br /> Legal Description: l-6 1 :C / '1 'i✓ C j D f� -l� — S <br /> Lot#: CSM Vol. Pg.gf OR <br /> n' <br /> Lot#: Block#: Subdivision Name: OR r„ � <br /> Gov't Lot#: OR 1/4 1/4 1� 0 N <br /> Section#: Town#: N Range#: _W Town of: i d✓1 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* j� <br /> ll )) <br /> Parcel#(24 digits): / -d)d - y �4 (�5 y i t� ]�► 0/ G0 D fi t' <br /> C N <br /> Tax ID#(1-5 digits): <br /> H _ <br /> Property Site Address#: t <br /> Road Name: l G fe✓a° rC'n City: /O`^Al d T �°`C Sa 1 0 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:I oco <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building s <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> `o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> 0 � <br /> ❑ Permit Extension LJ Gazebo-WI Stat 59.692(Sv) Camping Unit ❑ Commercial Acc. Addition C <br /> Proposed Structure/AdditionUse: Ci4r�pl uYltv�' 4 Z D <br /> (Ho /Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> Building Contractor: Z <br /> Z0N <br /> Anticipated Start Date: � G)0 o <br /> C <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> b <br /> z <br /> m <br /> A <br /> m <br />