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LAND USE PERMIT APPLICATION—Burnett County. WI b <br /> w � <br /> Permit Fees: 0 th <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C <br /> Dwellin 'nci I Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family 5200 <br /> CommercialAndustrial Building $300 Addition to ComaterciaVIndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse $250 E <br /> 1 � <br /> Accessory Structure-Commercial C 1&11) $200 Addition to Accessory Structure-Commercial Cl&I l $200 (]Q <br /> Deck/Stairs/Patios 5125 I Gazebo Stat 59.692 lv $350 0 1 <br /> < (� <br /> Camping Unit $100 Filling/Grading $150 r� r1 <br /> Permit Extension(Valid for one year-Onl IAllowed $100 <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:pergolay,landscaping,retaining walls. <br /> v <br /> a <br /> Applicant Compl 11 Sections Below This Line o . <br /> Applicant's Name: ��' <br /> Applicant's Mailing Address: �! L 9tP B ✓ �� + 5/ �� w <br /> ity State zip <br /> 7�y yip <br /> Applicant's Telephone Number. y'7(Po y <br /> Applicant's Email: A It 14 <br /> e-i✓; ivc VIOLA,2a. o#1i d <br /> I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone DEmail o I" <br /> a_ <br /> Legal Description:15T ADD r a &IMJ/ WrI atvriz-9t (&Mate/e,i 0(940T r �rr <br /> Lot#: CSM Vol. Pg. OR d <br /> Lot#: Block#: Subdivision Name: OR - V <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: _,_W Town of: .K u5 Ire <br /> *Attach additionalpage i needed or lent description OR attach a co o the deed OR attach tax system property H <br /> Pgef f 819' P copy y P PeY <br /> Parcel#(24 digits): 07- 9471-`X-. 3el <br /> Tax ID#(1-5 digits): f <br /> w <br /> Property Site Ad #: <br /> Road Name: Lc Z �t �✓ L Ak vt _--Crty._ .__ U 1' It <br /> 4 <br /> TYPE,PIF PERWT(S):Check appropriate box/boxes Fee Red—too <br /> CO <br /> W'Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure r" <br /> N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑Camping Unit D Commercial Acc.Addition <br /> /' 0 <br /> Proposed Structure/Addition Use: C.`i, Y- f2 4'lam t C <br /> (Ho /Cabin;Commercial Business;Bedroom;Deck;etc.) gym' <br /> O <br /> Building Contractor: e KiAA Yl 5� E _ �;4�'1Tr R f'S k Z <br /> Anticipated Start Date: 15E/ / crl, 0 w <br /> T— Page l of 4 d Z 0 <br /> Burnett County,WI Land Use Application—Rev 3/2015 y L)0 _o <br /> Z `� <br />