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LAND USE PERMIT APPLICATION— Burnett County, WI Cr <br /> y. <br /> N H1 <br /> Permit Fees: ; �+ <br /> o. <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 �7 O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 (� <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 o <br /> Camping Unit $100 Filling/Grading $150IS— <br /> Permit <br /> PemutExtension Valid for one year-Onl IAllowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. 63 j <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. V� <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 S <br /> Z <br /> Applicant's Name: La v . L err,O i. <br /> Applicant's Mailing Address: o?7(0/ G +y rY3 9 3 <br /> // City State zip <br /> V00 <br /> b <br /> Applicant's Telephone Number: 67 /o� — 6 36 ` S^6 0-7 o y <br /> C C> <br /> N <br /> Applicant's Email: ✓ e I'31 qt,% aw <br /> �.N m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b � t <br /> ❑Letter 'hone ❑Email N <br /> 0 <br /> Legal Description: t <br /> Lot#: IV CSM Vol. / Pg. C7 7 OR C <br /> N <br /> A <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 / ` 0 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v y 1 <br /> Parcel#(24 digits): O 7 0 d ` a _,yo _/q — 01 O <br /> Tax ID#(1-5 digits): / a 47 z <br /> y � <br /> N <br /> Property Site Address#: 7 (o / <br /> Road Name: C-y R d City: to e-L'S 1t <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:iwcv <br /> 13Single Family Dwelling El Multi-Family Dwelling ElFilling/Grading E3Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> m <br /> ❑ Stairs El Acc. Structure(Non-bunkhouse) L3 Bunkhouse L3 Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc. Addition °z� W C� 1 <br /> Proposed Structure/Addition Use: �"N f.,y Z n <br /> (Home/Cabin;Comniercial Business;B d om;Deck;3'etc.) a.,l <br /> Building Contractor: ®W 1.0i t1 <br /> 0 t" <br /> Anticipated Start Date: ice" i 7 a U�/6 m <br /> Z s, <br /> Page 4 4 <br /> Burnett County, WI Land Use Application —Rev 1/2016 ; Q <br /> m <br /> a <br /> m <br />