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LAND USE PERMIT APPLICATION—Burnett County, WI ar <br /> Permit Fees: g- .-__E:.!. <br /> 1Dwelling/Princi al Building Single Family 5300 Addition to Dwelling/Principal Building Single Family $200 :. O <br /> Dwelling'Principal Building-Multi-Family 00 Addition to Dwelling/Principal Building-Multi-Family $200w <br /> Commercial/industrial Building S300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structurc/Addition to Acc.Structure S150 Bunkhouse $250 2- <br /> I <br /> Accessory Structure-Commercial(C1&11) S200 Addition to Accessory Structure-Commercial(CI&I I) $200 <br /> Deck/Stairs"Patios S125 Gazebo(WI Stat 59.692(Iv)) $350 G') t <br /> Fe <br /> Camping Unit $100 Filling/Grading $150 r <br /> r- <br /> Permit Extension(Valid for one year-Only I Allowed) $100 .9 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. c„ <br /> *Communication Towers&Signs require a different application form,see corresponding application and fres. m. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. s7 ow <br /> :r ��,� r �mo' -�,�, r;- r i <br /> �t It a 11114 <br /> `L <br /> t r <br /> Applicant's Name: HO rid ¢ Lin Uk 9 e4 --- <br /> Applicant's Mailing Address: 3,1 Del.' AveW gotemsafl M v <br /> 2,2, .(6.> <br /> City State Zip n <br /> -7 ‘.3 33 1 -Applicant's 10 w. <br /> Telephone Number: 02 g d <br /> / � F <br /> Applicant's Email: J /�L�7 n; 5-7 e (4 l't (G5-7, n t-� (�� o <br /> _ i <br /> if staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone IIFb <br /> inail o " 1 <br /> Legal Description: / c > v fi/ y 1 ` <br /> Lot#: b <br /> r <br /> _ CSM Vol. Pg. OR ^ <br /> Lot#: Block ft: Subdivision Name: OR 2, a,P''' i a <br /> Gov't Lot#: OR 1!4 1/4 ` <br /> Section#: Town#: N Range#: W Town of: <br /> H <br /> *Attach additional page if needed for lengthy description QR attach a copy of the deed OR attach t t system property page.* <br /> D? - d,� 0 -#2 -1-0 -1 b - 107 -5- 1S-S o- d? aoo `0 <br /> v"]-o - c/0- 16 —l0 , -c-. -s$0 - 0;941" i'�� <br /> Parcel#(24 digits): pU n Q,u ,., 0 <br /> Tax ID ft(1-5 digits): 02- al" 3-02 4 Q"II\ 1 r' z <br /> Nm ill <br /> Property Site Address#: e /3 �� � <br /> Road Name: ,E0'.$7 yell oW n;iic-R R d City: <br /> • <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> Single Family Dwelling U Multi-Family Dwelling U Filling/Grading ❑Commercial Building <br /> U Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> U Stairs U Acc.Structure(Non-bunkhouse) U Bunkhouse U Commercial Acc.Structure <br /> U Permit Extension U Gazebo-WI Stat 59.692(1v) U Camping Unit D Commercial Acc. Addition C <br /> Proposed Structure/Addition Use: 010 19 1 s-iN I=; <br /> ria <br /> (Horne/Cabin,Commercial Bhainess:Bedroom,Deck:etc.) <br /> 5 co ( 5,.1 <br /> Building Contractor: }-/a Ro, l// t° ¢ Z FPO <br /> Anticipated Start Date: if A. 09 .- 01 6 ( I,✓l4 r7 F a's/ a in <br /> 41// /20/ d Page 1 of 4 i. <br /> 1 <br /> Burnett County, WI Land Use Application--Rev 412015 i C'"'-�� <br /> 1 <br />