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LAND USE PERMIT APPLICATION — Burnett County, WI & <br /> b <br /> 1n <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $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 CI &I1) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.6920vp $350 c <br /> < 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 S <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. Q <br /> 'o <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name: ✓7 jU <br /> Applicant's Mailing Address: 8 6 D 3 foo ry ±�r4 Lt /f, qG,/ ,c�- <br /> 7 City State Zip <br /> Applicant's Telephone Number: �� S'- G 7 - Y <br /> Applicant's Email: tl O k o Gam'•? ( �, vr�r �e p <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> ❑L7etter Phone /❑/Email <br /> Legal Description: SLoD O llL <br /> Lot M CSM Vol. Pg. OR o <br /> 5. -L <br /> Lot#: Block#: Subdivision Name: OR r„ t <br /> Gov't Lot M OR AZ1/4 SA1/4 1 <br /> Section#: S Town#:�N Range#:_/ Town of: J e c7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Parcel#(24 digits): D 7 - 07,9' -,Z -VQ -I T-ASr-' 7 19 d Oj} - 0116200 <br /> (� <br /> z <br /> Tax ID#(1-5 digits): 1goG a y a <br /> w <br /> Property Site Address#: <br /> Road Name: "coo rr sztn , City:; fl �7 fir/ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: t C� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs YX Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z C <br /> � <br /> J Z <br /> Proposed Structure/Addition Use: S�a-r- 9 n 1- /-/ ),e a a 4 RZj omo <br /> (Ho elCabm;Commerci l Business;Bedroom;Deck;etc.) <br /> Building Contractor: C14 V I /1 �� � 0 � C== <br /> 0 o_ <br /> Anticipated Start Date: /�+p�1f - �GS vZ J/� m Z rn <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 'o <br /> x <br /> m <br /> a <br /> m <br />