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LAND USE PERMIT APPLICATION— Burnett County, WI b <br /> C <br /> Permit Fees- ' ~ <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> O <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 Ace. Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&11 $200 Addition to Accessory Structure-Commercial Cl&11 5200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 lv) S350 0 <br /> Camping Unit $100 Filling/Grading $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. n <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. !V <br /> ADDJ1ca4t',QoM2te"AHS0W6hj BeloWTM rtfjoo t Jh <br /> Applicant's Name: C•( ° Q <br /> � � n <br /> Applicant's Mailing Address: <br /> / City State Zip <br /> Applicant's Telephone Number: / �f( � ff <br /> a <br /> Applicant's Email: d <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Cbeck one below. r� <br /> 1Letter ❑Phone ❑Email N <br /> Legal Description: �,� Y�Z"( 0 �i <br /> Lot#: f CSM Vol. Pg.gj OR 1 $� <br /> Lot#: Block#: Subdivision Name: OR <br /> m � <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page / <br /> ifneeded for lengthy description OR attach acopy ofthe deed OR attach tax system property page. <br /> y <br /> Parcel#(24 digits): d / rL - �d ,- �J X9— 1 CA noo—on eo� r <br /> Tax ID#(1-5 digits): 5'�_3 1 r? z <br /> Property Site Address#: a 7 7 1 <br /> Road Name: r )f City: ! <br /> OF PERMIT(S): Check appropriate box/boxes Fee Rec: � <br /> Ingle Family Dwelling ❑ Multi-Family Dwelling LlFilling/Grading ❑Commercial Building <br /> Single Family Addition ❑ Multi Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> l : <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension LJ Gazebo—WI Stat 59.692(iv) LJ Camping Unit Ll Commercial Acc.Addition I` <br /> //�� <br /> Proposed Structure/Addition Use: ( 1 It SQ /7 PC?r/IL N Z v <br /> � (Nome/Cabin;Commercial Business:Bedroom;Deck;etc.) Z efl <br /> Building Contractor: `7���J` , Z 0 N €� <br /> Anticipated Start Date: <br /> Page 4 <br /> Burnett County, WT Land Use Application—Rev 4/2015 � ��.�-- <br />