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Cn <br /> LAND USE PERMIT APPLICATION —Burnett County, WI & " <br /> et <br /> � � t <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to DwellingjPrincipal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $159 Bunkhouse $250 1 <br /> Accessory Structure-Commercial C1&II $200 Addition to.Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692 Iv $350 c <br /> Camping Unit $lOe Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed sloe <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 /> ro <br /> Applicant Complete: All Sections Below This Line c . <br /> Applicant's Name: ����\�//� 1' ��p�sg� t P <br /> Applicant's Mailing Address: ��1J� V\�GT sle. �� .,\ '"`� �U05 <br /> (! City State Zip ro <br /> Applicant's Telephone Number: C�S�� �57—�jc �t�5 0 <br /> Applicant's Email: <br /> l' w �- <br /> iD <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone Email N � <br /> 0 <br /> Legal Description: t - ��s�6js \ 5' <br /> n <br /> Lot#: Z CSM Vol.—ZPg. Q 15x3 OR o <br /> Lot#: Block#: Subdivision Name: OR 5 1 <br /> L1 m <br /> Gov't Lot#: -I OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: Lam. TeO���►tG I�J�f 1 <br /> O <br /> *AKach additional page:fneededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* —3 <br /> 1 <br /> Parcel#(24 digits): 07 Q�W—Z 73%-\5 3S_ S nS— cola—013 coo <br /> Tax ID#(1-5 digits): \6��13 ❑ x <br /> I <br /> Property Site Address#: <br /> Road city:\_-'a-'o\\e-'r\t \WSJ. <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:M. <br /> ❑ Single 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 <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> n � <br /> Proposed Structure/Addition Use: �a :��+w klsa\� ��p\� U'� Z <br /> jHome/Cab'l%,:Commercial Business,Bedroom;Deck;etc.) <br /> ��5 `- �� <br /> Building Contractor: n PCeC g�pv� eo <br /> 10 o o <br /> Anticipated Start Date:��» 2 Z o u u tl <br /> Page 1 of 4 9 1-- <br /> sc,t✓ Lzmx\ �-� Burnett County,WI Land Use Application -Rev 4/2015 4 �� <br />