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LAND USE PERMIT APPLICATION- Burnett County, WI c <br /> a <br /> Permit Fees: <br /> a /1_ <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 <br /> Dwelling/Principal Building-Muld-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 1 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 I <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w rl <br /> arm,see corresponding application and ees.*Communication Towers&Signs require a different aPPlicationf '- <br /> *Items not listed above will be treated as accessopy structures,such as:pergolas, landscaping,retaining walls. <br /> Applicant Complete <br /> / All Sections <br /> Below This Line <br /> Applicant's ant s Name: �Vt 9AgNgH2-T &' A4 ViVll�?� <br /> Applicant's Mailing Address: T07 <br /> = <br /> S/ bz*elk ZW <br /> City State zip <br /> Applicant's Telephone Number: 21�'7 Zf —ZYG y o y ry <br /> Applicant's Email: RAf V� Y,�l v <br /> d � <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. J <br /> ❑Letter rX.,Phone ❑Email N °0 ' <br /> Legal Description: SEIy of N��f° , S io.�! ht�g Al-io g6&QtpW /J 460 d 2- 1 <br /> Lot#: CSM Vol. Pg. OR52 <br /> C <br /> 7. <br /> Lot#: Block#: Subdivision Name: OR „ I <br /> Gov't Lot#: OR 1/4 1/4 o <br /> l � - <br /> Section#: Town#: N Range Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tar system property page. <br /> * 1 <br /> P 8 ` ./� % Y P PY I Y P P YPS <br /> Parcel#(24 digits): C5!2- O 3'2-- l-O4�—0 O 0 --(322 6 O <br /> z r7 <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: !'D /YIAr,y 5fr Fejt/ PWVR&Ay <br /> Road Name: f 3J� City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:Zc'�' <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> 13 Single Family Addition ❑ Multi-Family Addition LlDeck/Patio B"Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z <br /> n <br /> Proposed Structure/Addition Use: Ckg wA3k AQpk-,,y N <br /> (Name/Cabin;Commercial Business:Bedroom:Deck:etc.) 0 �( <br /> Z n <br /> Building Contractor: T r'S5ILP <br /> 4e(-/M oti-I c-h Z <br /> Anticipated Start Date: 045 Y' Z2 C)0 <br /> Page 1 of 4 C <br /> Burnett County,WI Land Use Application—Rev 1/2016 Z <br />