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LAND USE PERMIT APPLICATION—Burnett County, WI a r <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Fa 5200 - C <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 sL3 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building 5200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l y 5350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 �- <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different applicationform,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> ro <br /> m <br /> s <br /> Applicant's Name: I ISO <br /> Q <br /> Q S s'I1 <br /> Applicant's Mailing Address: a 3o y/ Jr- l�f, <br /> � r NIF � <br /> 6242 <br /> //,^, / r� City State Zip i b <br /> Applicant's Telephone Number. -3a?7--7Ye;L c 'k <br /> a <br /> Applicant's Email: 'P tJ V,4yl' a G}yy?,(Lt - Cc::,jin a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. j v <br /> ro <br /> ❑Letter XjPhone ❑Email N 00 \ <br /> 'Legal Description: ' <br /> d'o <br /> Lot#: CSM Vol. Pg. OR q <br /> 3. I <br /> Lot#: Block#: Subdivision Name: 11 OR <br /> Gov't Lot#:�OR 1/4 1/4 j . , �/ 9 1 <br /> Section#:_/�� Town#:�1YN Range#: l W Town of: // r <br /> 'Attach additional age if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* V <br /> Parcel#(24digits): (9]-(5 ,$-Uz' '{o-jy ' .Zy- 5 o.T-pUy'();L60JO Q <br /> J,48 L <br /> Tax ID#(1-5 digits): � � J O � z <br /> Property Site Address#: y <br /> Road Name: 9a6e "S 11 City: <br /> TYPE OF PERMIT(S):Check appropriate box/boxes Fee Rec-a0p vv <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> /Z Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo—WI`' t t5 59.692( V) 13 Camping Unit L3 Commercial Acc.Addition <br /> Proposed Structure/Addition Use: ��(/ F--oJ-��'+�J <br /> /� Commercial Business,Bedroom,Deck;eta) N Z <br /> (19 <br /> Building Contractor: A��/ �"�]�� r �� C�A-5 Z <br /> Anticipated Start DaAA1 � t° Q Q o <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 Z �� <br />