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LAND USE PERMIT APPLICATION— Burnett County, WI a _ b <br /> y ~ <br /> y �1 <br /> Permit Fees r to <br /> a <br /> Dwellin Princi al Building-Sin le Family $300 Addition to DwellinglPrincipal Building-Sin le Family $200 <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 Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 `" <br /> a <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) [$350 0 <br /> Camping Unit $100 Filling/Grading $150 (�y <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> ° v 1 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a n <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. rib <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. <br /> v <br /> Applicant Complete All Sections Below This Line S �. <br /> z <br /> Applicant's Name: M#.t� /�� <br /> UN <br /> Applicant's Mailing Address: (ZZ S c h�`/ /`�A- A�jty Wt( Sir /D <br /> City State Zip <br /> z <br /> Applicant's Telephone Number: ( �—4 � 2 4-7 0ls� 't <br /> Applicant's Email: o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b <br /> ❑Letter 43Phone ❑Email N °C <br /> 0 <br /> Legal Description: 4d <br /> o � <br /> Lot#: CSM Vol. Pg. OR y <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 �) ISU 0 <br /> Section#: Town#: N Range#: W Town of <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* y <br /> Parcel#(24 digits): 1 <br /> x <br /> Tax ID#(1-5 digits): z <br /> Property Site Address#: y pd <br /> Road Name: C_r) 0 KA1 �Z_ City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec-1 <br /> ••�PSingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 8 <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 3 <br /> Proposed Structure/Addition Use: )11`L Z C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> _-4 <br /> Building Contractor: DLLO-019- 4r V It u U <br /> N t� <br /> Anticipated Start Date: �Q I z�'/S r) c <br /> Page 1 of 4 0 �Z-1 <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> 9 <br /> S <br /> m <br /> a <br /> m <br />