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LAND USE PERMIT APPLICATION — Burnett County. WI & r <br /> C <br /> - b <br /> Permit Fees: o t"ii <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> B <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 0 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 = <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &I l $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(ly)) $350 0 <br /> Camping Unit $100 Filling/Grading <br /> $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. <br /> m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> *Items not listed above will be treated as accessory structures,such as pergolas,landscaping,retaining walls. <br /> m <br /> Applicant Complete All Sections Below This Line c �. <br /> � <br /> z <br /> Applicant's Name: +yah T)Ade r j <br /> Applicant's Mailing Address: 010 jyhlper NVC SoImCK6 Wt 5+02.5 <br /> City State Zip 0 , <br /> l05( ? 1 (� <br /> Applicant's Telephone Number: 491 4- < zo � y <br /> y, e <br /> Applicant's Email: rVQw JMLA I C0VY\ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. �" 1 <br /> w <br /> ❑Letter <br /> �Phont(1) ZEmail (2) <br /> Legal Description:Ption: (See �w \ea\ N <br /> Lot#: CSM Vol. Pg. OR <br /> y <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 F <br /> Section#: Town#: N Range#: W Town of: t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 67' 00(P' 2.35'17•Ilp•S 05-000 - 020000 <br /> Tax ID#(1-5 digits): 21 q z <br /> Property Site Address#: '170-7 <br /> Road Name: N MUd6h LAkG Dylve City: ,>)y(,V\ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:aH)oLD <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition y <br /> ❑Stairs Pi Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) 1rCamping Unit ❑Commercial Acc. Addition z <br /> p 12 X 1(o Shct� carrt�ihq Uhi� <br /> Pro osed Structure/Addition Use: y <br /> (Home/Cabin;Commercial Business;Bedroom; k;etc.) +"i r— <br /> Building Contractor: R i GIn Shires z <br /> Anticipated Start Date: q( 15 15 0 c=1U <br /> O <br /> Page 1 of 4 C G; <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />