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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> rn_ y Ir <br /> Permit Fees• ° n <br /> Dwell' cipal Building-S' a Famil Addition to DvicilurgRnncipal Build' -Sinale Family 5200 C7 <br /> Dwelfi c' Build' -Multi-Family 5300 Addition to Dweili c' al Buil ' -Multi-Family S200 , <br /> CommerciaUlndustrial Building 5300 Addition to CommerciaYindustrial Building $200 <br /> Accessory StruclurdAddition to Acc-Structure S150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial(Cl&11 5200 <br /> A <br /> Deck/Stairs/Pabos 5125 I Gazebo Stat 59.692(l vSM <br /> Camping Unit $100 Fill' $150 <br /> Permit Extension Valid for one year-Onl 1 Allowed S100 1 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> •Communication'fowers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as: las, ng,retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> 0 <br /> Applicant's Name: P /111 0. E <br /> Applicant's Mailing Ad s: /7 G YUL <br /> city state _Zip b <br /> PPTelephone <br /> Applicant's s Number: � 1 `•s �� o�y � <br /> Applicant's Email-Y �7 l 5- 6 S $ 5 0 <br /> a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter Phone ❑Email N <br /> o <br /> Legal Description: �' n <br /> Lot#: CSM Vol. Pg. OR O I <br /> Lot#: Block#: Subdivision Name: OR I <br /> hm <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#:-Town# N Range#:.� W Town of- 4,n G eJ4) <br /> 'Attach additional page if needed for fengthy description OR attach a copy of the deed OR attach tax system property51 <br /> page.` <br /> Parcel#(24 digits): <br /> a73� x <br /> Tax ID#(1-5 digits): /I � � � SJ <br /> Property Site Address#: <br /> Road Name: <br /> ���r City: , IV <br /> TYPE OF PERMU(S):Chedc appropriate box/boxes Fee Rec <br /> Single Family Dwelling L3 Multi-Family Dwelling ❑Fillirg/Grading ❑Commercial Building <br /> Single Family Addition ❑ Mufti-Family Addition ❑Deck/Patio ❑Commercial Addition <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑Bunkhouse ❑Commercial Acc.Strixture <br /> N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Add n <br /> Proposed Structu e/Addition Use: t� G/ D <br /> (Ho abm; nal Business;B m;Deck erc.) Z C ^� <br /> Building Contractor: C' � S 1 <br /> G <br /> v <br /> Anticipated Start Date: Jc:Page 1 of 4 <br /> Burnett County,W1 Land Use Application—Rev 4/2015 <br />