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LAND USE PERMIT APPLICATION —Burnett County,WI <br /> N y � <br /> Permit Fees: ° c a <br /> DwellingTriticipal Buil -Single Family 5300 Addition to Dwe But -Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial4ndushial Building $300 Addition to CommerciaVlndast[ial Building $200 v <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $2505 <br /> Accessory Structure-Commercial(Cl &11 $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692(lv)) $350 t �� <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *hems not listed above will be treated as accecsory.structures,such as_pergolas,landscaping,retaining walls. ! <br /> z <br /> Applicant's Name: ye,V KC,td p /n 3 0 Y1 p <br /> Applicant's Mailing Address: �Qv ! C Dur, R�. N )h,n� jj� ley L}I 5430 <br /> City I State Zip rni ro <br /> Applicant's Telephone Number: Jib <br /> (b <br /> c <br /> Applicant's Email: <br /> tt <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email N <br /> w° <br /> Legal Description: <br /> ao <br /> Lot#: a �_CSM Vol, _pg. y <br /> Lot#: Block#: Subdivision Name: OR T „ <br /> Gov't Lot M OR 1/4 11/4 7 <br /> Section#: Town#: N Range#: (L W Town of: SCr I <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> V 1 <br /> Parcel#(24 digits): 07— 02 8 lj0 - ly— O q-5©5-00 5 025081 1 <br /> m <br /> Tax ID#(1-5 digits): n z <br /> m x <br /> r <br /> Property Site <br /> //Address/#:.'�,, II rl (ZC' ff y <br /> Road Nam K� City: Darn.bur4 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Muni-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> >stairs ❑ Aox.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Aa.Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> C <br /> l CS <br /> Proposed Structure/Addition Use: z <br /> (IlomelCabin;Commercial Business;Bedroom;Dent;etc.) Z �O ;:0� <br /> Building Contractor: e(J2 Z 0c� <br /> Anticipated Start Date: r1)C C= <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br />