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LAND USE PERMIT APPLICATION—Burnett County, WIet <br /> r <br /> er <br /> b <br /> Permit Fees: a' <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingtPrincipat Building-Single Family $200 r, <br /> C7 <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercialtf Klustrial guild" $200 O <br /> Accessory StructuroAddition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&II $200 Addition to Accessory Structure-Commercial Cl&Il $200 I g <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692 lv $350 c <br /> --- <br /> Carming Unit $100 Fillip G $150 <br /> Permit Extension(Valid for one year-Only I Allowed $100 <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 /> �d <br /> Applicant'Complete All Sechons Below This Line <br /> Applicant's Name: o <br /> Applicant's Mailing Address: <br /> City State Zip y <br /> Applicant's Telephone Number: /0 <br /> _ 1,e'-010-Ildde <br /> Applicant's Email: &d& Q/" er,&dJiA&r�7-t &,97 <br /> If staff has a question about this application how do y u prefer to be contacted? Check one below. V <br /> b \ <br /> OLetter Phone Email a �C <br /> Legal Description: f(lyz Jlk W&A5 i <br /> Lot#: CSM Vol. Pg. OR d v <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 c <br /> 3 <br /> Section#: Town#: N Range#: W Town of: JAIMAI \ <br /> *Attach additional page if neededfor 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 <br /> Road Name:—& City: �Gl/►t4lUJ� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recd—_5D,ff <br /> ❑ Single Family Dwelling ❑ Mufti-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> y <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs 0 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure 0 <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑Commercial Acc.Addition C <br /> Z Mn <br /> Proposed Structure/Addition Use: <br /> (Home/Cabm, Comm&uil Business;Bedroom; ;etc) I <br /> � ,�q� �-'I <br /> Building Contractor: /��L//i t�LL� s t� ��/l�/V I <br /> ,1 <br /> Anticipated Start Date: d� <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> r" <br />