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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> z' ►d <br /> Permit Fees: ; in <br /> aki <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 �11Z 0 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &II $200 Addition to Accessory Structure-Commercial Cl &I I $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 c I <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. ?_ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> w <br /> m <br /> Applicant Complete All Sections Below This Line <br /> 13QtJ LoPPen/ z <br /> Applicant's Name: 71n TG c <br /> Applicant's Mailing Address: c,7-° l0 N W own .c15 /1h, r`i 3 3 <br /> City State zip <br /> Applicant's Telephone Number: 7(, 3 — 7 T-5- 6.2--7 l c y <br /> Applicant's Email: a' )o•i•t `t� L �•��"'��. Ce -� ° <br /> d <br /> d <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone KEmail °q <br /> 0ZZ <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR o <br /> y <br /> Lot#: '-4 ti`'S— Block#: Subdivision Name: Q e�r L l k(- 6-k Aid OR m <br /> Gov't Lot#: a OR 1/4 1/4 o <br /> Section#: /,3 Town#: N Range#: W Town of: <br /> *Attach additional page if neededfor lengthy descriPtion OR attach a copy of the deed OR attach tax system propertyPage. H V J <br /> Parcel#(24 digits): <br /> ( digits): oZ 335 <br /> n z <br /> Tax ID# 1-5 y � <br /> y _ <br /> Property Site Address#: = 9 `tt Awy .Lk /� <br /> Road Name: Fa w-+ Z�k_z �a�� City: Ja K b t r- <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: � <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Cl Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs A. Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure � <br /> N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C] <br /> n C <br /> Proposed Structure/Addition Use:ie aka y e Z <br /> ( ame/Cabin;Commercial Business;Bedroom;Deck;etc.) lTl <br /> Building Contractor: n e� C== <br /> ,1 O <br /> Anticipated Start Date: �� a{ Hr Stis"� o <br /> m C. cr <br /> Page 1 of 4 o Z <br /> Burnett County, WI Land Use Application —Rev 4/2015 <br /> 3 <br /> v <br /> x <br /> m <br /> a <br /> m <br />