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LAND USE PERMIT APPLICATION- Burnett Countya <br /> , WI b <br /> S <br /> y <br /> y 1� <br /> Permit Fees: ; to <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sinle Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 $ <br /> m <br /> Commercial/Industrial Building Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 unkhouse $250 I FO <br /> Accessory Structure-Commercial(Cl &II) 00 Addition to Accessory Structure-Commercial Cl &I1) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 <br /> 0 <br /> Camping Unit $100 Filling/Gradin9 $150 <br /> 0 <br /> Permit Extension Valid for one year-Only I Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> w <br /> *Communication Towers&Signs require a different application farm,see corresponding application and fees. <br /> *items not listed above will be treated as accessor <br /> y structures,such as:pergolas,landscaping, retaining walls. <br /> W <br /> Applicant Complete All Sections Below This Line er 2. <br /> Z <br /> Applicant's Name:De-17,#2o 426 rl p f� <br /> Applicant's Mailing Address:97$sro LDi,a PAG Rd W,aq,#r- A1# Is-"I/IT <br /> City State Zip nn <br /> y 3k <br /> Applicant's Telephone Number: J/�"- �Q6- ��„q ' o- c <br /> Applicant's Email: o <br /> w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter ®Ph a ❑Email N <br /> w <br /> 0 <br /> Legal Description: de- <br /> Lot#: CSM Vol. Pg. OR o <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 o <br /> I <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. <br /> Parcel#(24 digits): D>- D ao- ,2- S'O- i6".24'/DY"Oe7D' D/YObO <br /> x <br /> n <br /> Tax ID#(1-5 digits): /��'3� zy � <br /> m <br /> Property Site Address#: aXff yp 1 <br /> Road Name: /,04 C P,�7 p City: Ale"I r/' <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:IL:L� <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 <br /> El Permit Extension El Gazebo WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc. Addition C � 0 <br /> Proposed Structure/Addition Use: L'Q� s��y ��, o` eef �yq„���� �, > Z o <br /> (Home/Cabin;Com eYcia1 Business;Bedroom;Deck;etc.) m0 O <br /> Building Contractor: ,5'P ` Z n v r-- u <br /> Anticipated Start Date: m O <br /> o <br /> C �n <br /> Page 10 4 o Z <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> 3 <br /> v <br /> m <br /> z <br /> m <br />