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Cn <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> < b <br /> Permit Fees: o, <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 ) o <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo WlStat 59.692(lv)) $350 c <br /> Camping Unit $100 Fillin Gradin $150 <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. n <br /> w <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. <br /> Applicant Complete All Sections Below This Line c . <br /> Z <br /> Applicant's Name: /YJ/C#14F� J, V�KD6/y ° <br /> Applicant's Mailing Address: IV 7,6F <br /> P101 BOX a 9 City State Zip <br /> Applicant's Telephone Number: Ej4j 7:22w 6 93 o 't <br /> r <br /> G <br /> (D v <br /> Applicant's Email: AJOAJ,?!�_= ^p J <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑//Email N <br /> a� t <br /> Legal Description: ggQ jft Ql/i <br /> Lot#: CSM Vol. Pg. OR oCS <br /> �• 1 <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 f <br /> Section#:t�}T Town#: N Range#: W Town of: %I (V CGY1V ` I <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* -3 <br /> i <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): n 4z <br /> H <br /> Property Site Address#: <br /> Road Name: f/�r!_SENA R.D. City: tNEBsT,d5R <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�S <br /> Ingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ingle Family Addition. Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <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 9 C <br /> I^ n p u u <br /> Proposed Structure/Addition Use:-,MOW S f ler yN Z -v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) +"i0 <br /> �Z <br /> Building Contractor: &1/ di Z n dD <br /> ;6G)O N <br /> Anticipated Start Date: m Z M <br /> Page 1 of 4 c <br /> Burnett County, WI Land Use Application—Rev 1/2016 <br /> b <br /> m <br /> a <br /> m <br />