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LAND USE PERMIT APPLICATION—Burnett Countv. WI b <br /> Permit Fees: $ <br /> a <br /> Dwelling/Principal Budding-Single Family $300 Addition to Dwellin rinci al Building-Single Family 5200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVindustrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &II $200 Addition to Accessory Structure-Commercial Cl &11) 5200 <br /> a <br /> Deck/Stairs/Patios $125 Gazebo I Stat 59.692 Iv $350 g <br /> Camping Unit $100 FillinR/Grading 5150 <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 tee. v, <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 /> m <br /> Applicant Complete All Sections Below This Line c . <br /> ,�v� o <br /> Applicant's Name: o h O I I o P i e <br /> Applicant's Mailing Address:39Dcr w2 S-} C)eer I a(Cp Ro( Q.A,,.J WI S4830 <br /> City State Zip d <br /> Applicant's Telephone Number: - 7 115 - 9 -77 - Q 6 � L-( o <br /> e <br /> Applicant's Email. .ate �� ,nor-}eI p e� to b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b <br /> Letter Phone E3Email N <br /> °o <br /> Legal Description: <br /> Lot#: CSM Vol. DQ Pg. Q 4 q OR TV 31H /b '7 <br /> t? <br /> 3. <br /> Lot#:_ Block#: Subdivision Name: OR CA I <br /> Gov't Lot#: 3 OR 1/4 1/4 <br /> IIAJ <br /> It <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y () <br /> Parcel#(24 digits): 0 7 - b 3Q - ;;Z S 0S - 003 017 0o o r" <br /> A <br /> Tax ID#(1-5 digits): oD 13 13 z <br /> Property Site Address#: 31f`) `! <br /> Road Name: L✓,0,5+ De e P Lake RSI City: (Zn �r,r <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: o <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) ❑ Bunkhouse ❑ Commercial Acc. Structure m � <br /> LJPermit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit LlCommercial Acc.Addition m <br /> Cori l 0 M <br /> Proposed Structure/Addition Use: Rc-ai, S no moble 5 to I-Q P M.sc P � � Z D <br /> (Home/Cabin;Commercial Business:Bedr�dDeck:etc.) OZ <br /> Building Contractor: 1�5 e�� a A ON 12e a w Z p� <br /> /1 fV <br /> Anticipated Start Date:�D o l Do <br /> I toY/ rn <br /> \ " Page 1 of 4 <br /> Burnett County, WI Land Use Application-Rev 1/2016 <br /> ro <br />