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LAND USE PERMIT APPLICATION—Burnett County, WI s b <br /> Permit Fees: a 22 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin*Princi al Building-Single Family $200 O Nn+ <br /> Dwelling/Principal Building-Mult-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 �I�p'+' <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure r $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial(Cl&II) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> e <br /> Camping Unit $100 Filling/Grading $150 <br /> r <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. v <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 /> ro <br /> Applicant Complete All Sections Below This Line S <br /> z <br /> Applicant's Name: ' 1,t i t— P <br /> Applicant's Mailing Address. <br /> a�U� Si Q IIF MN SSc)�LI W <br /> I C ¢ f City State Zip , <br /> Applicant's Telephone Number. l9 J1 O Ll p Q u 0 3 " <br /> O y <br /> G <br /> Applicant's Email:moa,SCS WCCI <br /> d <br /> w <br /> iP <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter ,Phone 2Email N (M <br /> Legal Description: LOQ" \3 CSM L AIM V 23 U22 <br /> w <br /> t7 �' <br /> Lot#: CSM Vol. 15 Pg. OR 1 <br /> Lot#: Block#: Subdivision Name: OR 1 l <br /> Gov't Lot#: OR 1/41/4 7116 91 <br /> 6 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* y <br /> P 8 f I� 8Y P copy Y P P tJ'P8 <br /> Parcel#(24 digits):Q I -0 5LA -1-31 L 5-00 3 - 03(j ow � <br /> x <br /> Tax ID#(1-5 digits): 0 <br /> y � l <br /> Property Site Address#: M C6 <br /> RoadNamA,It1\�etfuAe 1A City: �ak U(�, <br /> TYPE OF PERMIT(S): Check appropriate box/boxes y Fee Rec:� 00 <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building S <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse Cl Commercial Acc.Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(1v) Cl Camping Unit ❑ Commercial Acc.Addition °z C <br /> Proposed Structure/Addition Use: S 'D f- C ll r Lqu �1 ,'\S - C'(avxt1 "'IBJ Z m <br /> (YfomelCabin;Commercial Business:Bedroom;Deck;etc.) �o m l�^� <br /> Building Contractor: <br /> Z 0 <br /> - �G)° �' C <br /> Anticipated Start Date: �C'n� 1\ U�5 m C v <br /> Z <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> m <br />