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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Z � <br /> Permit Fees: _ v, <br /> a <br /> DwellingfPrinci al Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial 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 &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only l Allowed) $100 c <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 dfferent 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 /> •o <br /> m <br /> Applicant Complete All Se tions Below This Line a 3. <br /> ry Z <br /> Applicant's Name: �3 G� <br /> Applicant's Mailing Address: f ✓C� / S �� �� �S U%� � <br /> City State <br /> Z115 gzcZip b <br /> z <br /> Applicant's Telephone Number: _ o y <br /> Applicant's Email: y�t d 1 <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> [-]LetterPhone ❑EmailUQ <br /> o °0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR d <br /> y <br /> Lot#: Block#: Subdivision Name: OR u 1 <br /> Gov't Lot#: OR 1/4 1/4 F <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if��nee//de��d��ror lengthy description OR attach a copy of the deed OR attach tax system property YPage.* y <br /> Parcel#(24 digits): S�s� <br /> ' X d <br /> Tax ID#(1-5 digits): r) z <br /> y <br /> m <br /> Property Site A ess <br /> Road Name: City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: i <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs *-Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> n <br /> ShA X > c <br /> Proposed Structure/Addition Use: / 4V C <br /> °z N Z z <br /> (Home/Ca rn��rcial Business;Bedroom;Deck;etc.) <br /> Building Contractor: .r..Z <br /> Anticipated Start Date: nZ <br /> L <br /> Page 1 of 4 0 "' <br /> Burnett County, WI Land Use Application — Rev 4/2015 <br /> x <br /> m <br /> M <br /> m <br />