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LAND USE PERMIT APPLICATION — Burnett County, WI a _ <br /> N ~� <br /> Permit Fees: t, <br /> a � <br /> Dwelling/Principal Building-Single Family $300 _Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Tamil $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 lv) $350 O <br /> Camping Unit $100 Filling/Grading Gradin $150 r 3• <br /> Permit Extension Valid for one year-Only I Allowed) $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 /> m^ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. 12 <br /> ro <br /> m <br /> Applicant Complete All Sections Below This Line o . <br /> z <br /> Applicant's Name: VV T6YUAU o <br /> 1 r <br /> Applicant's Mailing Address: l 1 rq M l T yhA rhL <br /> Ciq State Zip ni o <br /> 2t z <br /> Applicant's Telephone,/Number: QI P n�D !/I 0 1240 i o_ y 't <br /> Applicant's Email: K� {/1(j{� �, �1�L h�� ✓��� II rr d \ <br /> V1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter [Phone r [ Email N <br /> 0 <br /> Legal Description: ' <br /> Lot#:� CSM Vol*1161 116 V . 1 OR <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:-7._OR 1/4 1/4 J f <br /> Section#: , Town#: �40 N Range#:__[VW Town of: U 41 <br /> Q} y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* lT <br /> y Si.1 <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): ` yo"'1 � � m <br /> Property Site Address#: _ rr1��f -S0 <br /> Road Name: CUJ City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:3190 01D <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure C <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Proposed Structure/Addition Use: 0 rme f 1 .IA 1/yl/I 1 <br /> (Home/ abin;Commercial Business;Bedroom;Deck;etc.) m <br /> C z _ <br /> Building Contractor: L Mq✓� �51r tM (114 K <br /> Anticipated Start Date: m <br /> Page 1 of 4 0 CA <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> A <br /> M <br />