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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Permit Fees: 7' <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 l £O <br /> Accessory Structure-Commercial CI &I1) $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 C <br /> Camping Unit $100 Filling/Grading $150 <br /> 0 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 �— <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> w <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 /> Applicant Complete All Sections Below This Line <br /> ��)) <br /> 0 <br /> Applicant's Name: 0 AQP R <br /> Applicant's Mailing Address: (p 7 �/ S� -74) Sl • -e W /./v <br /> City State Zip <br /> r / � z <br /> Applicant's Telephone Number: {�7 d 4V�1 — P-6 ff 6 o y 'b <br /> c C <br /> m <br /> a <br /> Applicant's Email: G <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> E]Letter [`Aone ❑Email N 09 ` <br /> Legal Description: LG �s V,0 P 1?9 60V 4bl- 3 <br /> w <br /> Lot#:� CSM Vol. Pg. OR U <br /> { <br /> Lot#: Block#: �� <br /> Subdivision Name: OR F�. <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e. <br /> Pg f f gY P PYI' Y P P tYPg <br /> W <br /> Parcel#(24 digits): <br /> 1 n � <br /> Tax ID#(1-5 digits): ), n z <br /> UB ) <br /> Property Site Address#+: 0+ 1I �1 <br /> Road Name: ?-}moi 1 K , -70 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: Q� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> d <br /> ❑ Stairs �LAcc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition R ` J, <br /> -ll C <br /> Proposed Structure/Addition Use: a Z D B u u <br /> ome/Ca i • ommercial Business;Bedroom:Deck;etc.) R mBuilding Contractor: 1! YAR. 1.Lf L. V[[ i a w. I � 12:1 c Ha <br /> n^ <br /> 1✓ V <br /> O <br /> Anticipated Start Date: _ <br /> Page 1of4 c2 a <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> M <br /> E"n <br />