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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> N <br /> Permit Fees: °a <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200Lj <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250no <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial C1 &II) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. Q <br /> •o <br /> Applicant Complete All Sections Below This Line <br /> r� A n z <br /> Applicant's Name:: U I`�`c�� + . , j Si <br /> Applicant's Mailing Address: , yJ© W a.,�f)l.C..l S` • +—VeS c& t,( 57th-1 <br /> �7 _21y City State Zip tT b <br /> Applicant's Telephone Number: / 15 ' 2ff" o c 'k <br /> Applicant's Email:quD o l i, ''4N `t2_t_\ff w• c-orn O <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. S <br /> b <br /> ❑Letter Dfhonemail <br /> Legal Description: ' t <br /> Lot#: CSM Vol. Pg-Z3(oZI OR <br /> R%tle�yievl <br /> Lot#: Block#: Subdivision Name:�hln sen s olf <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: *35 Town#: L 1 N N Range#:IiW Town of: <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system propertyPa%e. <br /> t— 1 <br /> Parcel#(24 digits):— Q,3 2. — 2 — 4k — `6— 3S — 5 — kS ^ 3S I ^O 2J000 F � <br /> Tax ID#(1-5 digits): Z2�33 n z I <br /> II '_ff '_ � z � <br /> Property Site Address#: U11f12� w <br /> Road Name:'FI -e - D r. City: DowLj rq <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recap=1�' <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> H <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition a <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 z C --��--� <br /> n M <br /> n <br /> Cab fZ <br /> Proposed Structure/AdditionUse: 1 Qin a1V rrrr77 <br /> ( ome/Cabin:Commercial Business;Bedroom;Deck;etc.) 00 <br /> Building Contractor: OUSM C0()VFfL(L+ DC\ rcZ 0 Z. v <br /> XIO <br /> o <br /> Anticipated Start Date: < Z rn <br /> Page 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> A <br /> m <br />