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LAND USE PERMIT APPLICATION—Burnett County, WI `° r <br /> y H <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <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 O <br /> Accessory StnteturetAddition to Ace.Structure $150 Accessory Structure or Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&11 $200 Addition to Accessory Structure-Commercial Cl&11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $15U <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 `v <br /> *NOTE:After-the4act(when no permit is obtained prior to construction)is three times the normal fee. m <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. 7 <br /> ro <br /> Applicant Complete All Sections Below This Lime c . <br /> o <br /> Applicant's Name: k) D,S�j stn C/"Applicant's <br /> Applicant's Mailing Address: A 1-7 !"IAJc:r,r k A,,f— /'la/ /In JS Uf y <br /> City State Zip o <br /> Applicant's Telephone Number: �! L b ! VC) o <br /> Applicant's Finail: J.Pa/Lv <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. l <br /> w <br /> ❑Letter Phone ❑Email N � <br /> Legal Description: Lo+7 Pf.u�4 WVtt3puing RllfS a s/Jf&w', der 12 <br /> '("3-i a - R i 8W T�,�sF t7 <br /> Lot#:�CSM Vol. Pg. OR TYav�e t t y� t3vty C# <br /> 0 ' <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 E <br /> Section#: Town#:T 7 Z N Range#: Town of: <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed. <br /> 7 <br /> Parcel#(24 digits): 7 I-2-3 <br /> Tax ID#(1-5 digits): 3 3371 n z <br /> w 77 <br /> Property Site Address 4`: f o g Yg /1 1 w <br /> Road Name: W(^t r� L) Q-:�� city: J%Kd" �y /` e T+UJ( <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Re(: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition Multi-Family Addition Deck/Patio Commercial Addition <br /> � Ll <br /> ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> Z <br /> Proposed Structure/AdditionUse. �J �� /�,lLt � Z n <br /> (Name/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: f io r �? eo <br /> Anticipated Start Date: L 11A� A Lq.- I L"JVA^(n 1 � cn <br /> J Page 1 of 4 <br /> -g L� Burnett <br /> County, WI Land Use Application—Rev 3/2015 4 <br /> a5J 4er -� <br /> 7� <br /> A <br />