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LAND USE PERMIT APPLICATION — Burnett County, WI a _ <br /> N �1 <br /> Permit Fees: ; �n <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family <br /> Dwellin Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 � ` <br /> Deck/Stairs/Pados Gazebo WI Stat 59.692(lv)) $350Cam in Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one ear-Onl I Allowed) f$125 <br /> $100 <br /> 0 <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. 2. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> �u <br /> m <br /> Applicant Complete All Sections Below This Line . <br /> E 1/E►250/✓ z <br /> (/'� nn o <br /> Applicant's Name: �-VI(AX'qI�P�' tl, 1_ <br /> Applicant'sMailin D36 /9 C_ `A�5k°�' Tr- 5� ✓S 511 X71 <br /> City State zip <br /> X Applicant's Telephone Number: 71,5- 4G S-z D!�7 <br /> � Q N <br /> (D <br /> a <br /> Applicant's Email: o <br /> w <br /> iD <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter hone ❑Email <br /> N A <br /> Legal Description: , ) <br /> Lot#: j CSM Vol. Pg. ( OR V 11 d <br /> N <br /> A <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1I/4 f <br /> Section#: Town#: 2,��L_N Range#: l7 W Town of: 0 W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): ,j 3 1 y Mz <br /> Property Site Address#: a�fj 99 II-- <br /> RoadName: ..��C Tr I City:��l) Lc.l cb <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:-), `W•oo <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ,❑ Filling/Grading Cl Commercial Building z <br /> ,'& ingle Family Addition ❑ Multi-Family Addition Deck/Patio ❑ Commercial Addition 14 <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N � <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition s G <br /> n� <br /> H <br /> Proposed Structure/Addition Use: � r4 ,.,Z o <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc) -- <br /> 1 t�i <br /> Building Contractor: 1� <br /> Anticipated Start Date: mac. / k Jc:r Ac- PC <br /> Page 1 of 4 :�Z <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> --i <br /> b <br /> M <br /> m <br />