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LAND USE PERMIT APPLICATION— Burnett County, WI a _ <br /> in Nr <br /> Permit Fees: 7 vi <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 �7, C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 a- <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(iv)) $350 0 <br /> < ' <br /> Camping Unit $100 Filling/Grading Filling/Grading150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> d <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 /> �u <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: �fdtal p <br /> rlqV'Applicant's Mailing Address: V l b",` V'^ z <br /> I C*�l�`��� 1 � City State Zip � <br /> � z <br /> Applicant's Telephone Number: o H '� <br /> Applicant's Email: m e�Son I ��h(?O. O,�1n o <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> 1 <br /> ❑Letter hone ❑Email N W <br /> 0 <br /> Legal Description: <br /> 1 <br /> Lot#: CSM Vol. Pg. OR <br /> N <br /> A <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 £ <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* H <br /> P g f f g Y P PY f Y P P tY P g <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> y V <br /> Property Site Address#: <br /> Road Name: i10y r,c�4c�. Lo <br /> GYCR�1 City:At t) LcOL, <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Reczi00.co <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building Oji <br /> `Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> 0 <br /> E3 Stairs �'Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N � <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition ZO W <br /> Proposed Structure/Addition Use: H L_a Z C <br /> (Home/Cabin:Commercial Business;Bedroom,Deck;etc.) mN M r' <br /> Building Contractor: I j(1 �n SLSzZ o <br /> Anticipated Start Date: m�C <br /> Page 1 of 4 o Z <br /> Burnett County, WI Land Use Application—Rev 4/2015 > �� <br /> s <br /> 9 <br /> z <br /> M <br /> a <br /> m <br />