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LAND USE PERMIT APPLICATION- Burnett County, WI r <br /> a <br /> a' - ►e <br /> Permit Fees: ]' 71 <br /> a <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 /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo(WI Stat 59.692(lv)) $350 0 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one ear-onl 1 Allowed $100 <br /> 0 <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 /> �u <br /> m _ <br /> Applicant Complete All Sections Below This Line S . <br /> z <br /> Applicant's Name: IZU G L G e 411 L p <br /> Applicant's Mailing Address: 30 14.2 Ahlus juivr BL-.,AaAY p!/ 76"3o <br /> City State Zip <br /> Applicant's ant s TelePhone Number 15/5) 4G�l �3I6 <br /> o c <br /> a <br /> Applicant's Email: FSrn��/��o/22Zr- ,/✓jrj�Q�j��ItJFT d <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ZPhone ❑Email N i <br /> 0 <br /> Legal Description: 5' <br /> Lot#: CSM Vol. Pg. OR o 1 <br /> w <br /> n <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/473 9 <br /> o <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additionalPQge i e tach tax systemproperty pag .fneededfor!engthY descriPtion OR attach a copy o thdeedORat * y <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): z <br /> N <br /> Property Site Address#: 30/62 <br /> Road Name: 01=01CF-5 V JQ ( VE City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�s� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs >i,Acc. Structure(Non-bunkhouse) ❑ Bunkhouse LlCommercial Acc. StructureLN <br /> m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 2 �—�t <br /> M co <br /> Proposed Structure/Addition Use: �J�fV`d�e� > C `— r°d <br /> (Home abin;Commercial Business;Bedroom;Deck;etc.) <br /> N Z Z <br /> NM <br /> Building Contractor: z Z ( <br /> Z0 r+ <br /> Anticipated Start Date: � 7 90/6 0 M O j <br /> rn M <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 1/2016 ; (� <br /> m <br />