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LAND USE PERMIT APPLICATION -Burnett County, WI <br /> a <br /> Permit Fees: 0 a all <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C u I <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 n <br /> Commercial/Industrial Building $300 Addition to Commercial/Indusirial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 l <br /> Accessory Structure-Commercial C1 &I1 $200 Addition to Accessory Structure-Commercial CI&Il $200 a I 1 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692ly $350 0 <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <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 /> b <br /> _ qz� <br /> Applicant's Name: -7 ta*/7 tgLAZ&*_P 1 <br /> Applicant's Mailing Address 116- Nspetr <br /> �AyI <br /> City StatteelZOipM � �T <br /> Applicant's Telephone Number: Ocf- S7 18Z PQ_ <br /> Applicant's Email: wckz�4CktAyse. tomT61 C4 1 e kd <br /> I � <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone XEmail <br /> Legal Description:L_77 <br /> Lot#: (42 <br /> _CSM Vol. I0 g. OR <br /> 1 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: S OR 1/4 1/4 <br /> Section#: 23 Town#:�N Range#: 1ZW Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a j <br /> J <br /> Parcel#(24 digits): 07' Dab-2-9.0.17 "Z3"S--pS -OCS-- 01'7000 <br /> 1 <br /> Tax ID#(1-5 digits): 499J'� a `J <br /> Property Site Address#: 8 6 S( `' <br /> Road Name: CBpROVOL NAT RZ. City: 17ut/9 rt <br /> TYP&OF PERMIT(5): Check appropriate box/boxes Fee Recr✓ <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building S� <br /> ❑ Single Family Addition ❑ Multi-Family Addition Deck/Patio ❑ Commercial Addition11 <br /> Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: EIC/S714)0 mew.. <br /> �AT �fe a{C SEPTI C <br /> / (Homel `abin:Commeictal Business;Bedroom;Deck;etc.J <br /> Building Contractor: ,S C`J=1 i=011A603 �l R.Tou A#j-b ex (3e TIC <br /> IF <br /> Anticipated StartDate: �1 ST Z01 (e <br /> Page 1 of 4 <br /> Burnett County,W1 Land Use Application—Rev 1/2016 <br />