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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> y N <br /> Permit Fees: t!' <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwell in rinci al Building-Single Family L$250 <br /> C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building 0 <br /> AccessoryStructure/Addition to Acc.Structure $150 Bunkhouse Accesso Structure-Commercial Cl &Il) $200 Addition to Accesso Structure-Commercial Cl &11)Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) 0 <br /> Camping Unit $100 Filling/Grading $150 <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. <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 /> o <br /> Applicant's Name: h a <br /> , + L 1 1 ''--`` �j T <br /> Applicant's Mailing Address:_14b 4- CJAr,)Oo� r• I `0(J/la W( �t r�U <br /> Z I / Q n Qp City �iG State zip <br /> Applicant's Telephone Number: `�iS) o�� "l� I W (�IBJ) D J'O 0b o # <br /> Applicant's Email: J rCl,l. v J <br /> If staff has a question about this application how do you efer to be contacted? Check one below. <br /> ❑Letter ❑Phone Wmail 00 <br /> Legal Description: L ' <br /> Lot#: CSM Vol. Pg. ORDO <br /> t^ y <br /> Lot#: Block#: Subdivision Name: OR J <br /> Gov't Lot#: I OR 1/4 1/4 t <br /> Section#: �I Town#: 30D N Range#:__L:]_W Town of: <br /> *Attach additional age if neededror lengthy description OR attach a copy of the deed OR attach tax system property Page. a tA <br /> Parcel#(24 digits): 00 C N <br /> Tax ID#(1-5 digits): y �' <br /> Property Site Ad esus# -/ , <br /> Road Name: I///,ac � City: 3r61) <br /> f G <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee RY:3 O <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N a <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.AdditionCD <br /> �i^I <br /> L N <br /> Proposed Structure/Addition Use: x,..`71y � 3D � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m N Z D <br /> 'z O� ltC D <br /> Building Contractor: /c/�� - Z <br /> Anticipated Start Date: en (iJ" <br /> p ! i ) m�0 c=:) <br /> Page 1 of 4 c <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 'o <br /> x <br /> m <br /> A <br /> m <br />