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LAND USE PERMIT APPLICATION -Burnett County, WI a b <br /> N <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to DwellingtPrincipal Building-Multi-Family $200 Bt <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial(CI &11) $200 Addition to Accessory Structure-Commercial Cl &II) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> r <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. w <br /> *Communication Towers&Signs require a different application form,see corresponding application and jees. '- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> v <br /> m <br /> Applicant Complete All Sections Below This Line o '� <br /> 0 <br /> Applicant's Name: E10 <br /> Applicant's Mailing Address: ?Oog�g Or_�WGnt), LV-%_ ( `'I A-6-rWc- /jfw <br /> CityF State 341� 1 <br /> b3� -l� J F <br /> Applicant's t's TelePhone Number: < bx <br /> 2. <br /> Applicant's Email: op C� <br /> 0` <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. SL <br /> b � <br /> ❑LetterPhone ❑Email N <br /> Legal Description: N E N uJ S2&L-114W k l L W C N L Ili W <br /> Lot#:�_CSM Vol. V' g. 71 OR 1 ( ^A V 20 0 70I d <br /> t# 367SCe AtS AJ u) 5. <br /> Lot#: Block#: Subdivision Name: OR y <br /> Gov't Lot#: OR 1/4 1/4 f <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if neededjor lengthy description OR attach a copy of the deed OR attach tax system propertyPage. <br /> Parcel#(24 digits): <br /> X <br /> Tax 1D#(1-5 digits): <br /> Property Site Address#: <br /> Road Name: City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I-4Z, <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> y <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> o <br /> ❑ Stairs 0 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse E3 Commercial Acc. Structure N <br /> E3 Permit Extension 13 Gazebo-WI Stat 59.692(ly) L1 Camping Unit LI Commercial Acc.Addition zC <br /> n� `— <br /> 6—my-&A <br /> � Z c <br /> Proposed Structure/Addition Use: 6—my-& )1 G , <br /> r <br /> (Home/Cbi�mmercialBusiness:Bedroom:Decketc.) to� <br /> rroTLBuilding Contractor: 30\ VIL 0 <br /> " <br /> M <br /> Anticipated Start Date: m U u r+ <br /> Page 1 Of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> a <br /> x <br /> m <br /> A <br /> m <br />