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LAND USE PERMIT APPLICATION- Burnett County, WI 5- <br /> y' <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> d <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin Princi al Building-Multi-Famil $200 <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &II) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only I Allowed $10o b <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <br /> d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> m <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. Q <br /> W <br /> a <br /> Applicant Complete All Sections Below This Line 9 <br /> z <br /> Applicant's Name: iLh(IY��r1S�17�'�n <br /> Applicant's Mailing Address: 12�� EQ`,�{- {�i(1� LA�(j ,)OCar1l'r 1115 JLklio <br /> oty State zip <br /> Applicant's Telephone Number: c <br /> r <br /> a � <br /> Applicant's Email: o 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. t 1� <br /> ❑Letter phone ❑Email o I <br /> Legal Description: v' o"f 71O -'T W <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:_,,Z_OR 1/4 1/4 c <br /> 0 = I <br /> Section#: Town#: -3CA_N Range#:__Lq _W Town of: kA K ' p <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> Parcel#(24 digits): 0'7 <br /> Tax ID#(1-5 digits): J 5'jCD i y <br /> y <br /> Property Site Address#:� <br /> Road Name: r=, &te LAe ?,A City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:1�. <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 /> 0 <br /> ❑ Stairs IrAcc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> Ll Permit C <br /> Permit Extension Gazebo—WI Stat 59.692(ly) Camping Unit ❑ Commercial Acc.Addition <br /> n Z <br /> Proposed Structure/Addition Use: Q j y N Z C <br /> (Home a in:Commercial Business;Bedroom;Deck;etc.) Q <br /> Building Contractor: ? Z <br /> >7 o_ <br /> Anticipated Start Date: m CA <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 a <br /> 3 <br /> v <br /> x <br /> m <br /> A <br /> m <br />