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LAND USE PERMIT APPLICATION - Burnett County WI r <br /> F r, <br /> a 3 r <br /> Permit Fees: o' <br /> 6 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Fatni] $300 Addition to Dwelling/Principal Building-Multi-Famil $200 � <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 I—w� <br /> Accessory Structure/Addition to Ace.Structure $150'qt Bunkhouse $250 `"� 1 <br /> Accessory Structure-Commercial(CI &Il) $200 Addition to Accessory Stricture-Commercial(Cl &11) $200 <br /> Deck/Stairs,/Patios $125 1 Gazebo(WI Stat 59.692(lv)) $350 <br /> Camping Unit $100 Fillin 'Grading <br /> $150 .. <br /> r <br /> Permit Extension Valid for one year-Only I Allowed) 1 $100 0 <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 access.ry structures,such as:pergolas, landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line r 3. <br /> o — <br /> z <br /> Applicant's Name: Op 11/1) ,5% JUHNSnR <br /> Applicant's Mailing Address: ,a7j3t)-/571`/f 464&: 50, _56,577A,404, Mk <br /> City State Zip <br /> Applicant's Telephone Number: 6.5_/ 131_5 6.2079' o y <br /> c <br /> Applicant's Email: PyPf/T/? POr+1e/tST. /l!E']' d <br /> a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter %Phone ❑Email b <br /> N � <br /> c <br /> Legal Description: Q)G <br /> o� <br /> Lot#: al�l CSM Vol. Pg. $ OR <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 o <br /> E <br /> Section#: t-( Town#: t40 N Range#:�.(�W Town of: A SNA ° <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): d ! " t�a0 " a '-7 U-/G - l y - S 05— 004, —Q(3 p ocD r i <br /> / z <br /> Tax ID#(1-5 digits): 3 a /Q <br /> Property Site Address#: (- <br /> Road Name:__e I I� City: Shu <br /> TYPE OF PER1114IT(5): Check appropriate box/boxes Fee Rec: <br /> LJ Single Family Dwelling LJ Multi-Family Dwelling ❑ Filling/Grading Ll Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> M <br /> ❑ Stairs YAcc. Structure(Non bunkhouse) LJ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition { <br /> H <br /> Proposed Structure/Addition Use: Alyex(pE C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ONZ z <br /> Building Contractor: G—'eo�c om y G�rz.4 <br /> Anticipated Start Date:�yL-(,20/5' P. Z n N <br /> Page 1 of 4 8 C <br /> Burnett County,WI Land Use Application-Rev 4/2015 > Z <br /> b <br /> m <br /> m <br />