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rA <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal 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 etj <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> 7 <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 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w �^ <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 /> 'v <br /> Aplicant Complete All S tions Below This Line . Q, <br /> / z <br /> Applicant's Name: lily r!rr ( c <br /> Applicant's Mailing Address: Z__57 ,` ,.i o utn/ /1/Lv / <br /> City State zip eC� <br /> PPTelephoneCs� J ✓� c/ ��U �J <br /> Applicant's Number /// 0_ 't <br /> PP M S `t r l?J /�to1T'j40U / LOM <br /> Applicant's Email: 7 ` <br /> 00 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. V <br /> � <br /> / ❑Letter honed V r ❑Emmail/ / °q � <br /> Legal Description:L o� s/�. Ig3 V. /Z 1 l,7 ('✓de/nrn GO� O <br /> Lot#: CSM Vol. 7-133 9. 110 0 OR �et t'en Z d <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR �„ 1 <br /> Gov't Lot#: 2 OR 1/4 1/4 fi 1J o <br /> Section#: Town#: 9"d N Range#: 17 W Town of: <br /> 1 <br /> *Attach additional page if needed for lengthy description <br /> /O/R,attach a copy of the deed OR attach tax system property page. t7 <br /> * y <br /> Parcel#(24 digits): 67- G�— Z^ l(� .,Z44 - 5--0,5-- ODZ- 020eva <br /> 4 <br /> Tax ID#(1-5 digits): rZ <br /> Property Site TeZ#4?�_Road Name: t9cCity: <br /> �s� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Nc <br /> ElSingle Family Dwelling ❑ Multi-Family Dwelling El Fee Rec:Filling/Grading ❑ Commercial Building x <br /> Cl Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ,43runkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Additio z 00 C] <br /> V �I o.�� Par c � <br /> Proposed Structure/AdditionU; �" (� yic/� totc/C ,�1Q_1 C Z C <br /> . eit-aom;Commercial Bust ss;Bedr om;Deck;etc.J N M r <br /> �l o <br /> Building Contractor: / �� e uc o.- <br /> Anticipated Start Date: r C Oivr t o m G)0 <br /> Page 1 of 4 o Z <br /> Burnett County,WI Land Use Application —Rev 1/2016 <br /> m <br /> A <br />