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LAND USE PERMIT APPLICATION—Burnett County WI g r <br /> Permit Fees: s c <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Buildin -Single Family $200 = o ' <br /> O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Buil -Multi-Famil $200 <br /> Commercial/Industrial Buildin $300 Addition to CommerciaUindustrial Buildinp 5200 p <br /> WAccessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 , £ <br /> Accessory Structure-Commercial(CI&Il) $200 Addition to Accessory Structure-Commercial(Cl&Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading 5150 <br /> Permit Extension(Valid for one year-Only I Allowed $100 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 andJees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. W 2 <br /> Applicant Complete All Sections Below This Line <br /> �f1�i��'s Cgla�ne z <br /> Applicant's Name: ° <br /> PP g 2 767 A aref 0/pNe L✓ & Wl e -fAY3 <br /> Applicant's Mailing Address: <br /> City State Zip <br /> o p q 3 z <br /> Applicant's Telephone Number: 7i5��/6'O tOd`� Gd/�,�,s"/ <br /> dean v v 3746 di Aok t cow <br /> Applicant's Email: � o <br /> w <br /> R <br /> If staff has a question about this application how do ou prefer to be contacted? Check one below. v 1 <br /> ❑LetterPhone �I mail 0 _ <br /> 0 <br /> Legal Description: Aa <br /> Cv <br /> o <br /> Lot#:�_CSM Vol Pg. OR I <br /> Lot#: /7 Block#: Sit e: OR <br /> Gov't Lot#: ' J OR 1/4 1/4 71J j o <br /> Section#: —Town#: O N Range#:—L5---W Town of: AG: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Parcel#(24 digits): ✓ ? �l�' �/ �'!i �1 S�0 , t/�' - 0//�Q t7 m I <br /> n <br /> Tax ID#(1-5 digits): n z <br /> Property Site Address <br /> Road Name: �/�.1D� City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: o.00 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Mufti-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs 4J/Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure M <br /> ❑ Permit Extension ❑ Gazebo—NR Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc. Additio <br /> Proposed Structure/Addition Use: t/ ✓^p Z � <br /> (Home/Cabi ommercud Busine ,8e R Deck, etc.) Z C-) <br /> r"-7 <br /> Building Contractor: t-., Il <br /> 20 w r <br /> 4 <br /> Anticipated Start Date: f [✓ i' ; a�°nt� <br /> / <br /> Z <br /> < CJl <br /> Page 1 of 4 d <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> z <br /> m <br /> A <br /> M <br />