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C � C <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a . <br /> Permit Fees: ' CL <br /> Dwcllin rinci al Buildin -Si a Family $300 Addition to Dwelling/Principal Building-Sin le Famil $200 'a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin nci al Building-Multi-Family $200 <br /> Commercial/industrial Building $300 Addition to Commercial/IndustHal Building $200 V <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 l <br /> y4--�� <br /> AccessoryStructure-Commercial Cl&Il $200 Addition to AccessoryStructure-Commercial Cl &Il $2011 �.-1 <br /> $125 Gazebo WI Stat 59.692(ly $350 1 <br /> Deck/Stairs/Patios °< <br /> Camping Unit $100 Filling/Grading $150 r <br /> 0 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ' —> <br /> *Items not listed above will be treated as accessory structures,such as:pefgolas, landscaping.retaining walls. ro <br /> Applicant Complete All.Sections BELOW This Line o <br /> z <br /> 0 <br /> Applicant's Name: <br /> Applicant's Mailing Address: ' <br /> rr�� City State Zip � � <br /> Applicant's Telephone Number: � c d <br /> Applicant's Email: I C_"Pjf::2 �b t �` ' ►UC <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. l <br /> -o <br /> _� QLetter ❑Phone Email c <br /> c <br /> Legal Description: 0(L4O 350b O1 -q00 �1�n7 C�}D a1- I$-(7Jo 03 om-elleco y <br /> t7 <br /> Lot#: CSM Vol. Pg. OR y <br /> 5. <br /> Lot M Block#: Subdivision Name:f LZ-�2-?'} 1T)PR6b1 AY-1 OR v <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .i I <br /> Parcel#(24 digits): ©1-p 4 O -�- 3q- 1 S O fv-� 6� cow -C7(1 CCS Ft7' <br /> Z <br /> Tax ID#(1-5 digits): 1 �' <br /> Property Site Address#:IaG:1 CCyu»4%-1 AA F <br /> Road Name: F City:G V_fZ)-n- n.4)L4 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: _ <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑Stairs M Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C �� <br /> Proposed Structure/Addition Use: - <br /> (H ✓Cabin;Commercial Business;Bedroom;Deck;etc-) Z <br /> _ 1 _ m <br /> Building Contractor: <br /> n " � <br /> � � ° N <br /> Anticipated Start Date: �' <br /> Gig <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 1/2016 --�--I <br />