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LAND USE PEPJVHT APPLICATION—Burnett County WI Sr _ b <br /> Permit Fees: �' n <br /> a <br /> Dwelling/Principal Building-Sin a Family $300 Addition to DwellingfPrincipal Building-Single Family $200 \ C7PZ <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 Rt <br /> Commercial/Industrial Building $300 Addition to CommerciaVtndustrial Building $200 0 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &II) $200 Addition to Accessory Structure-Commercial Cl &11 $200 <br /> Deck/Stairs/Pados $125 Gazebo WI Stat 59.692(lv) $350 0 <br /> Camping Unit $100 Filling/Grading $150 < <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> o V ' <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. 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 /> ro <br /> Applicant Complete All Sections Below This Line . <br /> � . I z <br /> Applicant's Name: W2SLeyq 2 /�.� retre/y y� <br /> Applicant's Mailing Address: � 1 97 7j /-1 I Nei,114- (f lite a L ! f}nilgU/L`/ (�// S` o <br /> �7City State Zip ro <br /> Applicant's Telephone Number: /�-S h.-6 - 3Y2 o y <br /> Applicant's Email: <br /> If staff has a question about this application how doyou fer to be contacted? Check one below. <br /> ro <br /> ❑Letter hone ❑Email <br /> Legal Description: ee A-77144-e Q �' <br /> w <br /> Lot#: CSM Vol. Pg. OR <br /> a. <br /> Lot#: Block#: Subdivision Name: OR v, <br /> Gov't Lot#: OR 1A 1/4 <br /> Section#: Town#: N Range#: W Town of o <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y \l J <br /> Parcel#(24 digits): ° <br /> Tax ID#(1-5 digits): c) z <br /> m � <br /> N <br /> Property Site Address#: <br /> Road Name: (1 dy i r City: 0A jx-- <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> 13Single Family Dwelling ❑ Multi-Family Dwelling LlFilling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 'o <br /> ❑ Stairs j11� Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N 00C] <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) / Ll Camping Unit 13 Commercial Acc. Addition z Z c <br /> Proposed Structure/Addition Use: S- R trSt Sh 4-p /y X a I I� r <br /> (No a/Cabin:Commercial Business:Bedroom;Deck:etc.) t� <br /> Building Contractor: <br /> Anticipated Start Date: m <br /> Page 1 of 4 ` <br /> Burnett County,WI Land Use Application—Rev 4/2015 a <br /> 3 <br /> x <br /> m <br /> A <br /> m <br />