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LAND USE PERMIT APPLICATION—Burnett County WI CrC <br /> Permit Fees: <br /> a <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 = C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> C <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial CI &ll) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WIStat 59.692ly) $350 c <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. 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 /> 'v <br /> Applicant Complete All Sections Below This Line <br /> Z <br /> Applicant's Name: O 6,rj /� f� ° <br /> Applicant's Mailing Address: 7 /Z tr/9/T Dom IV Q, W�frJap/ly oj <br /> City State 7 Zip <br /> Applicant's Telephone Number: Z 3 SS"16V, ' a <br /> Applicant's Email: <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v �' <br /> ❑Letter Phone ❑Email tl0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> _ + `/t �. <br /> Lot#: Block#: Subdivision Name: ®L#7- �f / /tYl-S AO OR a, <br /> Gov't Lot#: OR 1/4 1/4 c <br /> Section#: Town#: N Range#: W Town of 441A PJ 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): N ' <br /> Tax ID#(1-5 digits): pit O - 113 Sy - 0A1 00 n <br /> Property Site Ad ss#: ; 00 <br /> Road Name: /Z QOrI) AI¢D City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 1so <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) Ll Bunkhouse ❑ Commercial Acc. Structure <br /> m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition Z <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) T Z <br /> Building Contractor: 92mov C.(�Jn� z O <br /> Z I Il- <br /> Anticipated Start Date:/ ST l7 O _o <br /> Page 1 of 4 Z <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> x <br /> m <br /> A <br /> M <br />