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LAND USE PERMIT APPLICATION—Burnett County, WI b r~ <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family 5300 Addition to Dwelling/Principal Building-Single Family $200 p <br /> Dwelling/Principal Building-Multi-Family S300 Addition to Dwelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building 5300 Addition to Commercial/Industrial Building $200 O <br /> AccessoryStructure/Addition to Ace.Structure S150 Bunkhouse $250 i <br /> rn <br /> Accessory Structure-Commercial(Cl&11) 5200 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> Deck/Stairs/Patios S125 Gazebo M Stat 59.692(lv)) $350 c <br /> Camping Unit S100 Filling/Grading Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year-Only I Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> 5 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. n ' <br /> a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> b <br /> Applicant's Name: MNWA&1 4' C7Wd9& otsoly c <br /> Applicant's Mailing Address: `: 1 goj4N <br /> City State Zip <br /> Z <br /> Applicant's Telephone Number: 217 c ' <br /> F <br /> Applicant's Email: ;Ti!PA VAAJW (r „ M 1 <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email c <br /> Legal Description: AA47AI LO{ 142 <br /> , <br /> Lot#: CSM Vol. Pg. OR d .) <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 /�/� <br /> /r 1-e V�ov, 1 <br /> Section#: Town#: N Range#: W Town o .t' _ I ` <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR at ach tax system property Page. <br /> Parcel#(24 digits): c7-oeg-.2-3i-ct9-3q-s 15-- 471`©zG000 c <br /> Tax ID#(1-5 digits): <br /> Property Site Address <br /> Road Name: City: S Rev <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: C-) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) gBunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazeboo—WIStat <br /> .59..692(ly) �j❑ Camping Unit L3 Commercial Acc. Addition W <br /> Proposed Structure/Addition Use: C--YAAat�I.B11AIVI`t�U5 Z <br /> (Homelfa in;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: <br /> q n <br /> Anticipated Start Date: 6- �1ALf22,c.y 140 �, C � <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> (n <br />