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LAND USE PERMIT APPLICATION- Burnett County, WI 0. C <br /> v , N <br /> Permit Fees: s to <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d joa^ <br /> Dwellin 'Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 V �" <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 M Q <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &ll) $200 Addition to Accessory Structure-Commercial(C1 &Il) $200 <br /> Deck'Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 n <br /> Camping Unit $100 Filling/Grading $150 <br /> r ' r- <br /> Permit Extension Valid for one year-Only 1 Allowed $100 v <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal tee. �J m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessog structures,such as:pergolas, landscaping, retaining walls. <br /> -o <br /> r, <br /> Applicant Complete All Sections Below This Line o �. <br /> I II- z <br /> Applicant's Name: �A-Y,j -4Oc we LL <br /> Applicant's Mailing Address: 6(r1)4u ao&n-A ZAp A oo . w I SyaCl3 <br /> City State Zip w <br /> ylo— , o <br /> Applicant's Telephone Number: 15 3y o U '� <br /> F I <br /> Applicant's EmaiI:1. FZ5T*,Z Mu�t3AZ- & YAttl.-3.n>m d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> [-]Letter Phone []Email v na t <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> i <br /> Lot#: Block#: Subdivision Name: OR = t^ <br /> t <br /> Gov't Lot#: OR 1/4 1/4 <br /> �^ <br /> Section#: Zv Town#: A4D N Range#: 15 W Town D <br /> t <br /> *Attach additionalpage ifneededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> � t <br /> _ G <br /> Parcel#(24 digits):67 bIZ-Z— LiO IS ZD-� D3' 600 v w <br /> Tax ID#(1-5 digits): 5`y'{Z ,�- z O <br /> ����"" � y 0 <br /> Property Site Address#: �CJ"G L0 t <br /> � d <br /> Road NamcG2o"T"` A' City: <br /> TYPE OF PERMIT(5): Check appropriate box/boxesJ <br /> f <br /> Fee Rea <br /> :3Single Family Dwelling LJ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition 01.Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z <br /> Proposed Structure/Addition Use: a <br /> (Flame/Cabin:Commercial Business:Bedroom;Deck etc.) m <br /> Q Z �? <br /> Building Contractor: Q <br /> r t� <br /> Anticipated Start Date: D�/Zy�Ze�15 _Z O <br /> Page 1 of 4 o C , <br /> Burnett County, WI Land Use Application-Rev 4/2015 > Z �7 <br /> ro �+ <br /> m <br /> A <br /> m <br />