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LAND USE PERMIT APPLICATION - Burnett County, WI a _ b <br /> y ^ i <br /> Permit Fees: a <br /> a <br /> d Dwellin rinci al Building-Sin le Famil $300 Addition to Dwelling/Principal Building-Sin Ie Fan-dl $200 �� �:7 � <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingjPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(CI &Il) $200 Addition to Accessory Structure-Commercial Cl &11) $200 ( `" <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 o <br /> Camping Unit $100 Filling/Grading $150 <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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2. <br /> _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. �2 <br /> Applicant Complete All Sections Below This Line �. <br /> �,J z <br /> Applicant's Name: F-J ; �2� w Lnr Oct <br /> Applicant's Mailing Address: A03 U -6. /1'�a, 1y oV&,, ,iL V Perk CA 913,;Zo � <br /> City State Zip w <br /> -1 <br /> Applicant's Telephone Number: <br /> — c <br /> Applicant's Email: t 411 n 1" Ct r'e.- 1-e eta C.c --rl6 arlr oldlcce j e crvl n t <br /> d <br /> r?At: 8066 e> ca-A <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> []Letter Letter WPhone 0° <br /> c � <br /> Legal Description:Zen SA 'S /ci/t CQ tz Wo, Ark 5' <br /> Lot#: CSM Vol. Pg. OR o of <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 f <br /> Section#: Town#: N Range#: W Town o£ c`kjrAYl J-- <br /> ° <br /> JL <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPaBe.* <br /> c <br /> Parcel#(24 digits): q 7 <br /> Tax ID#(1-5 digits): f� [v b J QT� <br /> Property Site Address A. a <br /> Road Name:_ k i City: DQ I1&A r y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec3 O 0 <br /> ArSingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> n C �- <br /> y <br /> Proposed Structure/Addition Use: Ol►'(Q, ;A y <br /> (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) <br /> 0 7 <br /> Building Contractor: <br /> Anticipated Start Date: / - n V 1 <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> r <br /> 9 <br /> .T. <br /> m <br /> M <br />