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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> �. <br /> Permit Fees: p' Vr <br /> Dwelling/Principal Building-Sinpje Family $300 Addition to Dwelling/Principal Building-Single Family $200 11,7a n <br /> DwellingRrincipal Building-Multi-Family $300 Addition to Dwellin ci al Building-Multi-Family $200 m <br /> CommerciaVindustrial Building $300 Addition to Commercial/Industrial Build' $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Accessory Structure or Bunkhouse $250 <br /> Accesso Structure-Commercial C 1&I l $200 Addition toAccessory Structure-Commercial C 1&I1 $200 ^ <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.6921v $350 C l <br /> Camping Unit $100 Fillip Gradin $150 < <br /> Permit Extension Valid for one year-Only 1 Allowed $100 0 <br /> QV <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. C, <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. w2 <br /> ro <br /> Applicant Complete All Sections Below This Line c . <br /> Z <br /> Applicant's Name: i c/ 37EyEr-3 M r.N"O -rR. <br /> Applicant's Mailing Address: lfbS-A 0MER•AXD DRt•E - u"jr A 14Vbo M4%) <br /> City State Zip ro <br /> Applicant's Telephone Number: Ctp l2 3100 -1 11(0A o <br /> e <br /> m <br /> 6 <br /> Applicant's Email: g rvtarin C9) h 4n4,alt_C,120M d <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v <br /> OLetter $Phone MEmail ro <br /> Legal Description: <br /> Lot#: f CSM Vol._,,,L_Pg. _ OR C <br /> Lot#: Block#: Subdivision Name: OR \ <br /> r I <br /> Gov't Lot#: OR 1/4 1/4 I g <br /> Fp it <br /> Section#: 015 Town#:--40 p N Range#: 1-7 W Town of: t.rlOP3 ' I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach L system property page. <br /> I <br /> Parcel#(24 digits): - OltaGoO . <br /> Tax tD#(1-5 digits): a.rj o53 ❑ Z I <br /> En � <br /> Property Site Address#: $a c(S — <br /> Road Name:_ PAQt_ Tr wp-.b- ' City: IAI�3s Lu <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:fp� <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Mufti-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structureto <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑Camping Unit EICommercial Acc.Addition Z C <br /> H Z > <br /> Proposed Structure/Addition Use: STO><2 WVL L3y 1LD ux%►�o e E S E() "N Z D <br /> r�T (Home/Cabin;Commercial Business;Bedroom Deck etc.) ��O <br /> Building Contractor: D ll -O —4 Q <br /> 0 <br /> Anticipated Start Date: S�1 �p'10l� C <br /> Page 4 w �u Il <br /> Burnett County, WI Land Use Application—Rev 3/2015 H <br />