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LAND VSE PERMIT APPLICATION— Burnett County, WI a <br /> < <br /> Permit Fees: in <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 U <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 .1 t <br /> Accessory Structure-Commercial CI &II) $200 Addition to Accessory Structure-Commercial Cl &II) $200 <br /> Deck/Stairs/Patios $125 Gazebo(Wl Stat 59.692(ly)) $350 c <br /> Camping Unit i $100 Filling/Grading $150 <br /> r <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 application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as: er olas, landscaping, retaining walls. <br /> •o <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name: £ [ c <br /> Applicant's Mailing Address:900 Ja14A[,5Uo1 4AV, --A" /UU �J44923 <br /> City State zip C b <br /> Applicant's Telephone Number: `l/S-g/o% - �*L71 _ z <br /> N # <br /> � q <br /> C <br /> Applicant's Email: Ox,7W Lr-1-46C C C F-V' "Y 7 a--rZ- <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> /n <br /> ❑Letter Phone ❑Email <br /> Legal Description: P6L �-yLf Lrr/. (A/p/LT Ir1T. f��J <br /> Lot#: CSM Vol. Pg. OR o <br /> rn <br /> 7. <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 W <br /> Section#: Town#: N Range#: W Town of: I o On <br /> *Attach additionalpage i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* -3 I <br /> PQ8 .l� f 8 Y P PY f Y P P tYP 8 � <br /> Parcel#(24 digits): 7-d.10 - -/le -4.5-S D 5-Do/9 <br /> Tax ID#(1-5 digits): `3G U 9 z <br /> H <br /> Property Site Address#: �n <br /> Road Name:, I. Jv tF ti� � wtl,�- 1('9,44 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building E <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 4 <br /> ❑ Stairs A Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> Ll Permit Extension Ll Gazebo-WI Stat 59.692(iv) L3 Camping Unit C3 Commercial Acc. Addition z <br /> \ <br /> /� <br /> Proposed Structure/Addition Use: CSL3tC.AG-Z- a <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> o <br /> Building Contractor: (�\ <br /> m <br /> Anticipated Start Date: m <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> b <br /> M <br /> a <br /> m <br />