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i - <br /> LAND USE PERMIT APPLICATION — Burnett Count', WI a <br /> y � 1 <br /> Permit Fees: g <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 � (� <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 t E <br /> 0 <br /> Accessory Structure-Commercial Cl &I1) $200 Addition to Accessory Structure-Commercial CI &11 $200 r <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension 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. <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 /> LU <br /> z <br /> Applicant's Name: W l 4Z/Q M P HOZ P5 ,t <br /> Applicant's Mailing Address://SA 7�ffA AW 0091,6-Al A4A( 5VJ3 <br /> City State Zip b <br /> /p z <br /> Applicant's Telephone Number: qs 91)V—,3 cyL O o c <br /> 6 � <br /> Applicant's Email: JAd <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> ❑Letter C2Phone ❑Email c 0Q t <br /> Legal Description: ' <br /> Lot#: CSM Vol. Pg. OR <br /> m <br /> Lot#: Block#: Subdivision Name: OR = �„ <br /> Gov't Lot#: OR 1/4 1/4 I <br /> 71 <br /> Section#:� Town#: 40 N Range#:�_W Town of: SCO t - ( IUJ <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): 0-7- O p1� a-YO�/ Y-/7-57 65' —O D a1 " 0/57o<30 <br /> � <br /> j � <br /> Tax ID#(1-5 digits): / -7 9 -7-2 d z <br /> m <br /> Property Site Address#: I f' S f-5,m <br /> Road Name: tA/ City: �ny e it e✓ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition '�LDeck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit EAension ❑ Gazeta-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition z � �DO <br /> R��1f_0 141MA r�& y z <br /> Proposed Structure/Addition Use: mm r <br /> (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) v <br /> Building Contractor: (CA 1q-SDti i1_4_(( /d-ee5 Z;ty C"- <br /> Anticipated Start Date: /V 44 )--6 f.5- m <br /> Page 1 of 4 o <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> v <br /> x <br /> m <br /> A <br /> m <br />