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LAND USE PERMIT APPLICATION —Burnett County, WI g _ <br /> N ^ � <br /> Permit Fees: p to <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 ti <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin rind al Building-Multi-Famil $200 K <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> ET1 <br /> Deck/Stairs/Patios $125 Gazebo 1 Stat 59.692(ly) $350 1 <br /> Camping Unit $100 Filling/Grading $150 <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. —d a, <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 /> o <br /> Applicant's Name: C Ar,5 l''�e-Yt <br /> Applicant's Mailing Address: t db Z 3 N&AA[dopa, Lyl SrJ'1 3 <br /> City State Zip <br /> Applicant's Telephone Number:- BbDLL M `4 k-- � o <br /> c G <br /> m <br /> a <br /> Applicant's Email: d <br /> t; <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> ❑Letter OPhone ❑Email N 1 <br /> '� 11 0 <br /> Legal Description: 'ham,.,, into 1,64- � -3-0V <br /> Lot#: ,_ji CSM Vol. Pg. OR d <br /> Lot#: Block#: Subdivision Name: T,e. kn,- Iit,L OR g <br /> y 1 <br /> Gov't Lot#: OR 1/4 1/4 ` 0 <br /> �� g 1� l�r�o"— t <br /> Section#: Town#: N Ran e# W Town of: <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> J <br /> Parcel#(24 digits): 0-'7 61 L Z At O 16- 11 15- 650 64i CC(D <br /> Tax ID#(1-5 digits): C,`1 Z <br /> Property Site Address#: <br /> Road Name: !1KI 4.1)Iomo C-d R,CA-- City: I <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:0�50> <br /> Ll Single Family Dwelling L3 Multi-Family Dwelling LJFilling/Grading ❑ Commercial Building �e� <br /> ❑ Single Family Addition ❑ Multi-Family Addition W Deck/Patio ❑ Commercial Addition <br /> Dj <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> H <br /> Proposed Structure/Addition Use: H o �1 <br /> tt r� (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) Z <br /> Building Contractor: lac_ I <br /> r� <br /> Anticipated Start Date: 8o <br /> Page 1 of 4 C Ln <br /> Burnett County,WI Land Use Application—Rev 4/2015 a <br />