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LAND USE PERMIT APPLICATION - Burnett County WI r <br /> 6 y� <br /> < V <br /> Permit Fees: <br /> 7 <br /> a 1 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 i< O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $290 <br /> AccessoryStructure-Commercial(Cl &11) $200 Addition to AccessoryStructure-Commercial Cl &II) $200 <br /> Deck/Stairs/Patios j $125 Lkazebo(WI Stat 59.692(l v)) $350 o 1 <br /> Camping Unit $100 Filling/Grading Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) 1 $100 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> v <br /> Applicant Complete All Sections Below This Line 0 <br /> z <br /> Applicant's Name: Xbv ld r /C:r n!" <br /> Applicant's Mailing Address: 3 j"2 W9- 5810 <br /> City State zip b <br /> Applicant's Telephone Number: c y # <br /> 2. e <br /> r <br /> Applicant's Email: o <br /> w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter C-Phone ❑Email w <br /> Legal Description: O <br /> Lot#: to CSM Vol. ) Pg. Z09 OR <br /> H I <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): gj ' 032—1­141 - 1';" 27- S O5-002~ OZ11#000 <br /> z <br /> 1 <br /> Tax ID#(1-5 digits): ���� y � <br /> N <br /> Property Site Address#: 'illa l$�] ) 1 h <br /> Road Name: l.,t VL 2_(00 City: ll <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: �S <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building z <br /> ❑ Single Family Addition ❑ Multi-Family Addition �Deck/Patio ❑ Commercial Addition y <br /> °m <br /> ❑ Stairs E3 Acc. Structure(Non-bunkhouse) El Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> � <br /> �+ n <br /> Proposed Structure/Addition Use: �-(� � Z M <br /> C <br /> (Home/Cabin:Commercial Business;Bedroom;Deck:etc.) � r ^� <br /> t_& VR U Il <br /> Building Contractor: n �3 o <br /> ciig <br /> N � <br /> O <br /> Anticipated Start Date: m c r <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> x <br /> m <br /> x <br /> m <br />