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LAND USE PERMIT APPLICATION— Burnett County, WI a _ C <br /> < b <br /> N - <br /> Permit Fees: <br /> 0. <br /> Dwelling/Principal Building-Single Famil $300 Addition to Dwellin iPrinci al Buildi <br /> ng 200 - O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin tPrinci al Building 200 <br /> Commercial/industrial Building $300 Addition to CommcrciaL7ndustrial B200 <br /> AccessoryStructure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> a <br /> AccessoryStructure-Commercial(Cl&11) $200 Addition to AccessoryStructure-Com $200 Deck/Stairs/Patios $125 Gazebo WI Slat 59.692(Iv) $350 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 ° <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w <br /> *Communication Towers&Signs require a derent application form,see corresponding application and fees. '- <br /> a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. 2 y <br /> Applicant Complete All Sections Below This Line o <br /> z l� <br /> Applicant's Name: v le L&G C 131— D <br /> 372 L 18 t1� 'nn , c r�1� nI , y 1 s5�oz o <br /> Applicant's Mailing Address: , .v <br /> Ci y State Zip b <br /> Applicant's Telephone Number: <br /> Applicant's Email: I e t 111 es R wsg C& C e 4 Ae, •fL44 G7 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter MPhone <br /> ❑Emaiil <br /> Legal Description: L� reoL+ Uk& `&A_ V o4AoV QRL 0° o <br /> i <br /> Lot#: CSM Vol. Pg. OR own m c3uC lx� o <br /> Lot#: Block#: Subdivision Name: OR >r1 <br /> r. <br /> Gov't Lot#: OR 1/4 1/4 I <br /> Section#: 1 Town#: qO M N Range#:_A_� _W Town of: ,f�CX 30 R b <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �� <br /> a't -opt-2-ya- 15-13 S 1 5-255-0 35000 p <br /> Parcel#(24 digits):01-0%L-Z 'q0' 05. 13-5 1�'ZS$� 03lraooa �r <br /> Tax ID#(1-5 digits):_ <br /> Property Site Address#: a�VJL�s <br /> Road Name: CT t'-ea+ . _Z*M `-;(''u r+ City:A0_4 50 r\ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Ree ,t'/� <br /> mingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> v, <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> 0 <br /> LJ Permit Extension L] Gazebo-WI Stat 59.692(ly) LJ Camping Unit LJ Commercial Acc. Addition Z <br /> W <br /> Proposed Structure/Addition Use: a <br /> c <br /> (Home/Cabm;Commercial Business:Bedroom;Deck,etc.) . h <br /> Building Contractor: 1 O.t+JIn L1hy-h`6''�/ '�►�2fj �� <br /> Anticipated Start Date: �-1 Z O(� O CD tJ � <br /> Page 1 of 4 a L", ° <br /> Burnett County,WI Land Use Application—Rev 4/2015 4 Z <br /> -C <br />