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LAND USE PERMIT APPLICATION- Burnett County, WI b r <br /> i <br /> <_ !b <br /> Permit Fees: 'o <br /> Dwelling/Principal Building-Single Family $300 ddition to Dwelling/Principal Building-Single Family $200 a O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Princial Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &11) $200 1 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c p <br /> Camping Unit $100 Filling/Grading $150 .. <br /> t, <br /> Permit Extension(Valid for one year-Onl I Allowed) $100 b <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m 4 <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. '- 1 <br /> *Items not listed above will be treated as accessory strictures,such as:pergolas, landscaping,retaining walls. `D <br /> Applicant Complete All Sections Below This Line o tC <br /> Applicant's Name: s <br /> ILS llbowbc _ <br /> Applicant's Mailing Address: <br /> City State Zip <br /> Applicant's Telephone Number: <br /> O <br /> Applicant's Email:0-y M)tL(1 rt n 0' 1?_hIi/t�Y It�'u*-A4,700 C� p <br /> T d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter hone ❑Email v <br /> Legal Description: <br /> Lot#: CSM Vol. g. OR <br /> t <br /> Lot#: Block#: Subdivision Name: OR <br /> t� <br /> Gov't Lot#: OR 1/4 1/4 1 S F tt 1 <br /> Section#: -3!j_Town#:_3_9_N Range#: /(a W Town of: A(e ll.,O u ;- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* L/t <br /> W ' <br /> Z <br /> Parcel#(24 digits): ��'y 1 �- J�' �'3`4 -3 A-0(JC - (7 ,)�1 <br /> (_i CC' <br /> Tax ID#(1-5 digits): I z <br /> d X <br /> Property Site Address#: L01�o ALy <br /> Road Name: 5y ad to City:_2m <br /> TYP)E OF PERMIT(S): Check appropriate box/boxes Fee Rec:�?W — <br /> ingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> //❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 5 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> //�1 <br /> C) Cr.� <br /> Proposed Structure/Addition Use: 'UNU�h e l 0!h N �� "' <br /> ( ome/Cabin;Commercial Business;Bedroom; k:etc.) Z 'O <br /> Building Contractor: GAIjNP)C� <br /> Anticipated Start Date: m c >� <br /> A [�)J (jf ooG)0 <br /> Page 1 of 4 .— <br /> Burnett County,WI Land Use Application—Rev 4/2015r <br /> 5 <br /> M <br /> F <br /> hf <br />