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LAND USE PERMIT APPLICATION— Burnett County WI a _ b <br /> N ti <br /> y <br /> Permit Fees: 0' n ur <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin Princi al Building-Single Family $200 O CW <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 g J" <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 (`�\ <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to A essory Structure-Commercial CI &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year.-Only 1 Allowed $100 c <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:pergolas, landscaping, retaining walls. <br /> �u <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: G;-R.V G e- U r1wYl P <br /> Applicant's Mailing Address: 77(% Y /J'L'PA'/ <br /> City State zip d <br /> 3 �c/ _ 3579 z <br /> Applicants Telephone Number: c y <br /> a <br /> Applicant's Email: 91 a a c e &b§,-&n, @ SZ/6.2-e./V C orry O t <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. i <br /> ❑Letter ,hone ❑]aEmail LOT <br /> N 00 <br /> Legal Description: L� 2 GS�C`T-L� �(6 1"1 LC�©� LO \ 2 <br /> Lot#: 2 CSM Vol.\1 Lk%Pg. 90� OR I <br /> Lot#: Block#: Subdivision Name: OR <br /> W <br /> Gov't Lot#: Z OR 1/4 1/4 1 F l <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y <br /> Parcel#(24 digits): 07 -()-Z9-2--40-iI4-3 C'S -0-5-007--012_000 <br /> 1 <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 1-7 X17 6 <br /> Road Name: City: Sr VOY1f(� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building s <br /> MSingle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> -o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition t�C) <br /> Proposed Structure/Addition Use: a cW0,°Vt 'kf SCgSon a <br /> ( e/Cabin;Commercial Business;Bedroom;Deck;etc.) Z 3;<- 'C= <br /> Building Contractor: \ (` rCJ tgss Cofvs�f" &DA `meq �('� R 8 M Q <br /> Anticipated Start Date: UA <br /> I m V <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 ;" <br /> r <br /> s <br /> M <br /> p <br /> m <br />