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LAND USE PERMIT APPLICATION —Burnett County, WI 9 b <br /> Permit Fees: o, <br /> DwellingiWncipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 > <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(C I &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Star 59.692(1 v)) $350 n I� <br /> o � <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension(Valid for one year-Only I Allowed) 1 $100 1 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application jonn,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergalas, landscaping,retaining walls. <br /> � 1 <br /> rt <br /> Applicant Complete All Sections Below This Line o . <br /> Z <br /> Applicant's Name: c Da <br /> Applicant's Mailing Address: SAND OJA 39sc3i M WE LT677.- <br /> City State Zip a <br /> Applicant's Telephone Number: <br /> Applicant's Email: 6146e bcli�a -ma.t .Coytti, d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter Phone alEmail <br /> Legal Description: LOT \ � ��a 1��3 \'!Q il Siti1 Ski ` St y <br /> 100 <br /> Lot#:l CSM Vol. o1 Pga3(e"-2 31 OR <br /> Lot#: Block#: Subdivision Natne: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: c�X-1 Town#: '25 _N Range#: V1 W Town of:ZAA�F-LS ) <br /> *Attach additional age i needed or len gthv description OR attach a copy o the deed OR attach tax s.vstem rro rerh page. <br /> * y <br /> page j / 5 P P j 1 l P k <br /> Parcel#(24 digits): 6DO Q2 -tet ✓���, ` �-�( - ��� "p�� ®1l �aQ � <br /> a <br /> Tax ID#(1-5 digits): JmZ <br /> Property Site Address#:r2$$91' <br /> Road Name: City <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I5v•M <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwell ng ❑ Filing/Gracing ❑ Commercial Buwlcmg <br /> y <br /> ❑ Single Family Addition ❑ Multi Family Add tion ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs Acc Structure (Non-bunkhouse) ❑ 8cnkho-tse ❑ Commercial Acc- Structure m <br /> ❑ Permit Extension ❑ Gazebo -WI Stat 59 [.92(1v) ❑ Car ping Uni Ll Commercial Ace- Addition Z <br /> Z <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin:Commercial Business;Bedroom:Deck:etc.) b D <br /> -O <br /> Building Contractor:k-VE(r-, \v,!;,7 '— �'y KckE- ��-��.-. \ �a� Y'. .2�� � ^� <br /> C ( - <br /> Anticipated Start Date: J Il J (Lo 0 a <br /> Page 1 of 4 c 2 <br /> Burnett County,WI Land Use Application—Rev 1/2016 -----� <br />