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LAND USE PERMIT APPLICATION— Burnett County. WI a _ b <br /> y ^ 1 <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin 'Princi al Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 `J O <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse $250 � <br /> Accessory Structure-Commercial(CI&Il) $200 Addition to Accessory Structure-Commercial(CI&It) $200 t^ <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692 Iv $350 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. r fi <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. i <br /> o � <br /> Applicant Complete All Sections Below This Line N c . <br /> Applicant's Name: (�",qps #� i`o^rpt dtf7j ^ �, '�n /� -�- <br /> Applicant's Mailing Address: 1 0 Q ptC or okb Or&;,, Sa.., 'V. 1b. ��f7�Z b <br /> City State Zip <br /> Applicant's Telephone Number: o y G <br /> Applicant's Email: / b)cn o Q Clt <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. tr T <br /> ry ❑Letter COPhone ❑Email 0 00 t <br /> Legal Description: OQ <br /> Lot#: CSM Vol. Pg. OR 4 O <br /> t <br /> Lot#: Subdivision Name: Pr,YtC-eSf Pi zr S{te,A,pR a <br /> Gov't Lot#: OR 1/4 1/4 <br /> 1 W <br /> Section#: Town#: N Range#: W Town of: a h['C9 v� l <br /> 1 <br /> *Attach additional page ijneeded for lengthy description OR attach a copy of the deed. <br /> Parcel#(24 digits): m S <br /> � z � <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: ���a d <br /> l I,i �1 O <br /> Road Name: JS l 414*►a City: L...)-,C-L-s 1-4--- <br /> TYPE <br /> --9— W <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: QU <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> $Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 8 <br /> ❑ Stairs ❑ Acc, Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Ga -WI Stat 59.692(ly) ❑Camping Unit ❑ Commercial Acc.Addition z <br /> 'z <br /> " pD � r7 <br /> Proposed Structure/ it77 <br /> Fi4 ( a �o > C <br /> ( m a i , ^ c etc.) O _ <br /> 7 G <br /> Building Contract /�z�' /1��/ z <br /> C <br /> Anticipat art Da <br /> Page 1 of 4 0 r� <br /> Burnett County,WI Land Use Application—Rev 3/2015 ; O JI <br /> z �F <br /> m •- <br />