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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> y 1 <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwellin iPrinci al Building-Multi-Fxmil $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse 5250 ) <br /> Accessory Structure-Commercial(CI &11) $200 Addition to Accessory Structure-Commercial(Cl &I1) $200 0 r <br /> Deck/Staim'Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 (��\ <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Ont lAllowed $100 ° <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form, see corresponding application and fees. 3 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> t <br /> rn <br /> r � <br /> z <br /> Applicant's Name: 0"1� R' 0A AL <br /> Z<.--1� A0esZ5-4oF- 1—a.I Wrat,a8Vt8 }i �jSIZ <br /> Applicant's Mailing Address. h � <br /> City State Zip <br /> (pi 2— —ZQ[* -7ZS(� crlZ (gSl -2b .sOF?$ z <br /> Applicant's Telephone Number: o u <br /> C <br /> Applicant's Email: o�n •y1 c,t-+Q s n p e-+1 Lc}r`P. 6O y+'1 a t <br /> �o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. �% I <br /> K J^ <br /> ❑Letter Ophone ❑Email c <br /> Legal Description: RtJE70— OaS 5' J� <br /> Lot#: CSM Vol. Pg. OR o a `� <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot it: OR 1/4 1/4 o li <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e ifneededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): 01 —OZ � —Z " +l C9 — i(v-O' —$ t� -4" . 033000 U <br /> w <br /> Tax ID#(1-5 digits): l''>} � n z <br /> N <br /> Property Site Address it: Z 9 O <br /> Road Name: 0 City: DAkA Q'A ft Y <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs PrAcc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑Commercial Acc.Addition <br /> to <br /> Proposed Structure/Addition Use: �� <br /> (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) Z T [9 u u <br /> Building Contractor: Rte '�� �1�4`L�-.�'�/ �+�pV ITI <br /> Anticipated Start Date: Sa'y's�* Ze I1� 0 dO <br /> Page 1 of 4 C a <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> �'7 <br />