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i <br /> LAND USE PERNIIT APPLICATION— Burnett County, WI a b <br /> N <br /> Permit Fees: c <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 r O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> CommerciaUlndustrial Building $300 Addition to CommerciaUlndustrial Building $200 0 <br /> Accessory Structur ddition to Acc.Structure $150 Bunkhouse $250 1 1 1� <br /> a <br /> Accesso Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial(Cl &Il $200 r <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(ly) $350 c <br /> Cam in Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year-Only 1 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 /> */terns not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> ro <br /> 0 <br /> Applicant Complete All Sections Below This Line <br /> z <br /> a <br /> Applicant's Name: ark 1 S ��� ` <br /> Applicant's Mailing Address: W15Z6 YWA 17 ,Ie,- ri»,c /yl/J <br /> City State Zip b <br /> Applicant's Telephone Number: o <br /> // <br /> Applicant's Email: A)0/44 zat'S -SG��t'r<9 • �" o <br /> d <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b <br /> ❑Letter ❑Phone Email N <br /> 0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 I )• f l <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional age if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* ) <br /> Parcel#(24 digits): 4/0-14 -&Y- s' 1S- y3S- O/baoo I <br /> z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: L aY (o <br /> Road Name: Lail q N�y ole.4 Laµe City: l),A b u.r ti <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building x W-ElSingle Family Addition El Multi-Family Addition ElDeck/Patio ❑ Commercial Addition o OD <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> o <br /> ❑ Permit Extension LJ Gazebo-WI Stat 59.692(ly) Camping Unit Ll Commercial Acc. Addition z CD <br /> n G <br /> Proposed Structure/Addition Use: -A e ot av <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -'a N m M <br /> 00 <br /> Building Contractor: AA;aA2 K Z <br /> neo C <br /> Anticipated Start Date: 8�Z�/gam „ C <br /> Page 1of4 o Z lluu <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br />