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0 b <br /> LAND USE PERMIT APPLICATION - Burnett County, WI Cr b <br /> y <br /> H <br /> Permit Fees: to <br /> a <br /> Dwellin rinci al Building-Sin le Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 V o <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial CI &Il) $200 `' <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 C1 <br /> 0 <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <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 /> ^o <br /> Applicant Complete All Sections Below This Line �. <br /> z <br /> Applicant's Name: _ o S � (j� <br /> Applicant's Mailing Address: Ul `^Q i /j/ SYY ya OQ <br /> City State Zip <br /> ` / ` <br /> PP P 71 5 - S�7 —Q # <br /> Applicant's Telephone Number: <br /> Applicant's Email: ��r r2® 507 zrlUp pVA-T- o <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. Su <br /> 1 <br /> ❑Letter NPhone ❑Email t <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR y <br /> i <br /> Gov't Lot#: OR 1/4 1/4 i <br /> Section#: Town#: N Range#: W Town of: �) <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax * J y <br /> P % f j 8 Y P PY / system property page. ' ,1 <br /> W <br /> Parcel#(24 digits): <br /> x <br /> a <br /> Tax ID#(1-5 digits): n z <br /> Property Site Address#: 3 m /J // �^ �– <br /> Road Name: C� �d Z, Cif-- iC ,Y5?to lim it p City: /Bcu.1 ©f AdL —sotA <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:a1 QV <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N <br /> 0 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition Z � <br /> Proposed Structure/Addition Use:���� Z <br /> (Hom /Cabin;Commercial Business;Bedroom;Deck;etc.) � 0 m r (� <br /> ° Z I c� <br /> Building Contractor: {�Zo an .fl <br /> Anticipated Start Date: A <br /> Page 1 of 4 u tt Il <br /> Burnett County,WI Land Use Application— Rev 4/2015 <br /> m <br />