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LAND USE PERMIT APPLICATION— Burnett County, WI a ro <br /> Permit Fees: o fit <br /> DwellinglPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial4ndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial C 1&11 $200 Addition to Accessory Structure-Commercial(Cl&I l $200 <br /> Deck/Stai s/Patios $125 Gazebo WI Stat 59.692 lv $350 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will he treated as accessory structures,such as:pergolas, landsca in ,retaining walls. <br /> �o <br /> Applicant Complete Ali Sections Below This Line �. <br /> z <br /> Applicant's Name: Grax I (�r P <br /> Applicant's Mailing Address:_ 50 Qta "VA Cfi• Wwa <br /> City T State Zip <br /> Applicant's Telephone Number: A70-- CC <br /> Applicant's Email: tiara -tieigi-h (50 olowa. eaLi s <br /> If staff has a question about this application how do you prefer to be contacted? Check one below, v <br /> ❑Letter [gPhone QEmail <br /> N � <br /> Legal Description: 01 - G 2 -2- -Yo "tel- .2 vo —0130 O D 1 <br /> Lot#: iAs(aCSM Vol. aS Pg. a:� OR o 1 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 g <br /> Section#: Town#: N Range#: W Town of <br /> l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Cj <br /> Parcel#(24 digits): o� O/Sra-� 0 DO I —O t a5bo [ <br /> Tax ID#(1-5 digits): 1:) l67 ��r z <br /> Property Site Address#:,X74Q 6 'Sk- �_e Road <br /> Road Name: 51 a kms- City: 5?60 n e r <br /> A <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Reda <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Pado ❑ Commercial Addition 6 <br /> ❑ Stairs M Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Aa. Addition C <br /> c: Z <br /> Proposed Structure/Addition Ilse: Z'fftC <br /> omelCabin:Commercial Business;Bedroom;Deck;etc) 171 r— U <br /> L� <br /> Building Contractor: WCD <br /> p <br /> Anticipated Start Date:�j� Emu 0 <br /> Page 1 of 4 ® Z <br /> Burnett County,WI Land Use Application-Rev 4/2015 0 <br />