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LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> Permit Fees: a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 W <br /> Accessory Structure-Commercial CI &Il) $200 Addition to Accessory Structure-Commercial Cl &I1) $200 no <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ' <br /> m <br /> *Items not listed above will be treated as accessory structures,such as:pergolas.landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: TA C rC S o r\ <br /> Applicant's Mailing Address: -2CT(3 W Jet t/c f to, 0r-tAv ll—al 5Y?Vj 11 <br /> City State zip <br /> Applicant's Telephone Number: 7 i S 7 ?1 3 ? o y <br /> Applicant's Email: / .'1 TWekso•, t5Q ayjn4s(bu qc ' ar.-, fir I d • <br /> w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> l <br /> ❑Letter {Phone ❑Email N <br /> Legal Description: Nw -SLJ <br /> Lot#: CSM Vol. Pg. OR o <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 / E <br /> Section#: _3 Town#:__3.�N Range#: ..L_fLW Town of: C L a k -C- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v" <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): zz <br /> Property Site Address#: 10/A �( p <br /> Road Name:_ 91)a AA La k C R d City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec GD <br /> ASingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension Ll Gazebo—WI Stat 59.692(ly) El Camping Unit Ll Commercial Acc.Addition <br /> (y� D <br /> Proposed Structure/Addition Use: 1 ' t O d v I a r k o rv\e "E• <br /> (Home/Cabin:Commercial Business;Bedroo ;Deck;etc.) <br /> // f-+ <br /> Building Contractor: h�!" ton p y�. � <br /> CD, <br /> / C' <br /> Anticipated Start Date: �- / � <br /> ' ` f�h' <br /> Page 1 of 4 m 1 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> b <br /> m <br /> M <br /> M <br />