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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Permit Fees: <br /> a <br /> DwellinglPrincipal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Famil $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 a <br /> Accessory Structure-Commercial Cl &II) $200 Addition to Accessory Structure-Commercial Cl&II $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(1 V) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed $loo S <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. 1e <br /> b <br /> i <br /> Applicant Complete All Sections Below This Line : <br /> D(� z <br /> Applicant's Name: 4)0)//) y <br /> Applicant's Mailing Address: Y �s Z ////15#//y -f< 411a0I37 <br /> City State zip <br /> Applicant's Telephone Number: 1.4617 <br /> ti- g L Z- 1Oo1 z <br /> o <br /> c <br /> m <br /> Applicant's Email: o <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ; <br /> b <br /> ❑Letter II/Phone ❑Email 0 00 1 <br /> Legal Description: <br /> Lot#: d _CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: L a kea w o o JS OR r„ <br /> Gov't Lot#: OR 1/4 1/4 F <br /> c <br /> Section#: Town#: N Range#: W Town of: I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 1 J ` y <br /> Road Name: � ktrs Lan t_ City: D UrOv�V <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec.� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> y <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> °z <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition 4 <br /> et <br /> y <br /> Proposed Structure/Addition Use: a x L(w t e-tl T�' rS.Y� 4Q CJt kf(NC11�- Z D 8 u u <br /> (Home/Cabin;Contmercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: clsVivo <br /> n o <br /> N <br /> Anticipated Start Date: mZ rnJ�U' <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> 3 <br /> 9 <br /> x <br /> m <br /> A <br /> m <br />