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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> y � , <br /> i <br /> Permit Fees: c <br /> n <br /> Dwelling/Principal Building-Single Family 5300 Addition to DwellinWilrincipal Building-Single Family 5200 d <br /> Dwelling/Principal Building-Multi-Family S300 Addition to DwellingfPrincipal Building-Multi-Famil $200 <br /> Commercial/Industrial Building S300 Addition to CommerciaVlndustrial Building 5200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse S250 <br /> Accessory Structure-Commercial C]&11) 5200 Addition to Accessory Structure-Commercial CI&11 $200 <br /> Deck/Stairs/Patios $125 Gazebo I Stat 59.692 lv S350 <br /> 0 <br /> Camping Unit $100 Filling/Grading Filling/Grading50 " <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed 5100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee n <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. / <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. �/ ) <br /> 'o <br /> Applicant Complete All Sections Below This Line c <br /> z <br /> 0 <br /> Applicant's Name: <br /> Applicant's Mailing Address: `i`t r`t I AJ NC= r� t t>< P .-n,4 .5 ro zs <br /> City State Zip a <br /> Applicant's Telephone Number: l - 7 rr 3 b 2-v'� <br /> Applicant's Email: 1 ^� S:�l� �* �^•-'c. , c-- "� a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. V i <br /> a <br /> ❑Letter ®Phone NO Email c <br /> Legal Description: S t$ -T 3 fr N —Z `t w w <br /> Lot#: t q CSM Vol. Pg. OR rJ <br /> Lot#: 1 al Block#: Z Subdivision Name: t-. -H t r¢ OR n <br /> y <br /> Gov't Lot#: OR 1/4 1/4 � <br /> 7Q � <br /> Section#:_ Town#: N Range#: W Town of: <br /> *Attach additional e i needed or lengthy description OR attach a co o the deed OR attach tax stem property e. <br /> page f f gt Y P PY � sY P pertly pag <br /> Parcel#(24 digits): S) ', .-', 3 * -(Y 60-57, r S YNc D 3 2- 01-0 r- <br /> n z <br /> Tax ID#(I-5 digits): 3 73� m <br /> N <br /> Property Site Address#: 2.3(o t F� h <br /> Road Name: Sc-+1%c`a-. t_n City: 't n a!r Die c �e <br /> TYPE OF PERMIT(S):Check appropriate box/boxes Fee Rec:l� <br /> ❑Single Family Dwelling ❑ Muld-Family Dwelling ❑Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑Deck/Patio ❑Commercial Addition <br /> ❑Stairs Acc.Structure(Not-bunkhouse) ❑Bunkhouse ❑Commercial Aa.Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition z <br /> z � <br /> c� C <br /> Proposed Structure/Addition Use: �� O <br /> (Home/Cabin;Commercial Business;Bedroom;Uoeck;etc.) Z C-) <br /> � lS CJ <br /> Building Contractor: 5 e,-1+ r_o - s "Z t� <br /> Anticipated Start Date: <br /> Page 1 of 4 o Z [� <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> x ��-- <br /> M <br /> z <br /> m <br />