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LAND USE PERMIT APPLICATION—Burnett County XN'I a <br /> Permit Fees: 22. E2 <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to aBuilding-Multi-Family O <br /> $200 r- g <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 p <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 7 <br /> Accessory Structure-Commercial CI &II $200 Addition to Accesso Structure-Commercial Cl &I l) $200 <br /> a <br /> Deck/Stairs/Patios <br /> $125 Gazebo(WI Stat 59.692(]v)) $350 c <br /> Camping Unit $100 Filling/Grading �- <br /> $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 o <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 /> ^o <br /> rn <br /> Applicant Complete All Sections Below This Line �. <br /> �j <br /> Applicant's Name: z <br /> ° <br /> Applicant's Mailing Address: napo P <br /> ^� ���� ity State Zip � b <br /> Applicant's Telephone Number: c # <br /> /� <br /> Applicant's Email: I -OZC�©ma? C.pmeaal <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. SUJ <br /> ❑Letter /[]Phone <br /> Phone []'tmail <br /> Legal Descr.+ / /� t77(�� 'J�/ j OW ' 5 <br /> Lot#: CSM Vol. Pg. OR C <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 ( v I <br /> Section#: TownNRRange#: 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): <br /> Tax ID#(1-5 digits): z <br /> 7° <br /> Property Site Address <br /> Road Name: City: V <br /> f <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 7� <br /> Fee Rec:a <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ElN]utti-Family Addition LlDeck/Patio Ll Commercial Addition <br /> Stairs W Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat/59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition n C <br /> Proposed Structure/Addition Use: r/�Z ki�lz �J <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) N Z 3� <br /> Building Contractor: K Z ao Fn <br /> Z Q C=Anticipated Start Date: 'ate L7 v C <br /> Ln <br /> �YJ""'Page 1 of 4 o G � <br /> Burnett County,WI Land Use Application—Rev 1/2016 0 <br /> x <br /> m <br /> a <br /> m <br />