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LAND USE PERMIT APPLICATION— Burnett County WI <br /> Permit Fees: N <br /> s <br /> Dwelling/Principal Building-Single Family <br /> $300 Addition to Dwellin /Princi aI Building-Sin le Family $200 �� O <br /> Dwelling/Princia1 Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/industrial Building 5300 Addition to Commercial/Industrial Building $200 ( J O <br /> Accessory Structure/Addition to Acc.Structure S150 Bunkhouse $250 <br /> Accessory Structure-Commercial(C1&11) S200 Addition to Accessory Structure-Commercial(Cl &1I) $200 17 <br /> l <br /> Deck/StairsiParios $125 I Gazebo(WI Star 59.692(Iv)) $350 0 <br /> Camping Unit $100 Filling/Gradin! <br /> $150 <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> *NOTE:After-the-Fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Conununication Towers&Signs require a different application forns,see corresponding application and lees. <br /> *Items not listed above will be treated as accessory structures,such as.pergolas,landscaping, retaining walls. <br /> v <br /> Cotitglpii id`its Beier' <br /> Applicant's Name: X04 W ql� L 7�sa n <br /> Applicant's Mailing Address: / J .Z JQ�� ✓P /`/ AW;,fiate mo Ssy ppp <br /> City State Zip r <br /> 33l < z <br /> Applicant's Telephone Number: -7 5-a o <br /> �y V <br /> Applicant's Email: 0 .,;n� � J�� tv L � 1�"t C G S7. � C� <br /> 1f staff has a question about this application how do you prefer to be contacted.' Check one below. <br /> b <br /> ❑Letter Phone [Email <br /> o <br /> Legal Description: f$e } o�y <br /> Lot#: CSM Vol. Pg. OR b V) JA <br /> Lot#: Block#: Subdivision Name: OR a <br /> Gov't Lot OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of j�le deed OR attach t x system property page. <br /> 0'7 - d� 0 -, -L1� d3aaot� <br /> Parcel 4(24 digits): <br /> v 1-v�4-a -No- Itf -� 7 -S— IS -510 — 0.299o0 <br /> Tax ID ft(1-5 digits): a <br /> Property Site Address#: o' 9 0 /3 Q y� <br /> Road Name: a 3 yell ow p! I✓�t4 /5 d City: <br /> i <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> Single Family Dwelling LJ Multi-Family Dwelling ❑ Filling/Grading LlCommercial Building _' <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure , <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Proposed Structure/Addition Use: (10 1 h � z T <br /> rn <br /> (Home/Cabin, Commercial Business:Bedroom;Deck;etc.) Z <br /> Building Contractor: -z RO H e <br /> / _ Z <br /> Anticipated Start Date: 7 ' N�i / @ ei7 /���f� o J� �', +� ��- <br /> c`a� <br /> Page 4 <br /> Burnett County, Wl Land Use Application—Rev 4/2015 �, <br />