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LAND USE PERNUT APPLICATION— Burnett County, WI a <br /> w N <br /> Permit Fees: °, c <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &II $200 <br /> Deck/Stairs/Patios 1 $125 1 Gazebo WlStat 59.692 lv $350 0 <br /> Camping Unit $100 Fillin Gradin $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 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 /> � T <br /> Applicant Complete All Sections Below This Line <br /> /+ o <br /> Applicant's Name: -J E+ir eA --4U01 t' oAI/ �t <br /> Applicant's Mailing Address: e�fO 01 7 es/.4M SXC/1 4We a AAA/ W-r sS ry <br /> City State Zip <br /> Applicant's Telephone Number: 7/5 - 3340- 4:VS0 o " <br /> a <br /> a <br /> Applicant's Email: o <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. i <br /> �o <br /> ®Letter �/�®Phone ❑Email o °C <br /> Legal Description: Se c A*4avei <br /> Lot#:_ CSM Vol. Pg. S-6 OR (J� <br /> 3. yl <br /> Lot#: Block#: Subdivision Name: OR a <br /> Gov't Lot#: OR 1/4 1/4 f <br /> 0 1 <br /> Section#: Town#: N Range#: W Town of: l <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): /02 r) z <br /> Property Site Address#: <br /> Road Name: �'/g," S,4i e// I-AAU c City: Sj%Q p ti <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:a�,() <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> z � <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> z <br /> n � � <br /> A <br /> Proposed Structure/Addition Use: Sc.✓ Re o M1 i�J fT1 � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: S44P43QA��1�r-f lleA G,4/`1le 46oAS - f1'9yr/r4re &- Z 0 ~ � <br /> O N <br /> 0 <br /> Anticipated Start Date:- S-� Z rn <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> 9 <br /> 2 <br /> m <br /> z <br /> m <br />