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• LAND USE PERMIT APPLICATION - Burnett County, WI a �_ <br /> • N �1 <br /> Permit Fees: a ut <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin Princi al Building-Multi-Famil $200 V <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &II $200 Addition to Accessory Structure-Commercial CI &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> r 1(1 <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. rn <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 /> 'v <br /> Applicant Complete All Sections Below This Line <br /> D U hC-D Pt nd erst�n z <br /> Applicant's Name: ` rr � <br /> Applicant's Mailing Address: j u 1 Z� S} C"A Tt9 tL W i 54730 <br /> City State zip V\- © o <br /> Applicant's Telephone Number: j S —4 Vo - (OZ I c z <br /> y <br /> � 6 <br /> Applicant's Email: o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ecr �i9w <br /> Letter 'hone PA <br /> ` °�` l t <br /> ❑Email A�+l S GO•��'�v�Y rt t N <br /> Legal Description: 7 Jr <br /> o� <br /> Lot#: CSM Vol. Pg. OR l v, <br /> Lot#: 19 Block#: <br /> Subdivision Name: ASCp4 _f ed- OR „ <br /> Gov't Lot#: OR ^ 1/4 1/4 F <br /> Section#:�Town#: 9(7 N Range#:1]2_W Town of: OA r `cx4 <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. y <br /> * � <br /> I <br /> Parcel#(24 digits): 0-1 —(')ZO -Z -4 0 — I to—ZO -S t S -q31 - 0 31 Pon � <br /> Tax ID#(1-5 digits): 14 5-jo n z <br /> Property Site Address#: 1 <br /> Road Name: C _ r pii 11 I <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 y <br /> ❑ Stairs )iil"cc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C —�✓ <br /> Z <br /> Proposed Structure/Addition Use: 2 S Y Z <br /> 3 n <br /> (Nome/Cabin;Co ercial Business;Bedroom;Deck;etc.) <br /> afo <br /> 0 <br /> Building Contractor: o N <br /> C: �„ C <br /> n <br /> Anticipated Start Date: V Pt <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> A <br /> m <br />