Laserfiche WebLink
LAND USE PERMIT APPLICATION—Burnett County,WI 9 a: <br /> Permit Fees: , <br /> DwIlinglPrincipal Building-SbWe Family 5300 Addition to Dwell' Build -Single Fmmil $200 r O <br /> Dwellinzftmcipal Building-Multi-Family 5300 Addition to Buildin -Multi-Family 32" <br /> Commercial/Industrial Building $300 Addition to CommercieUlnduWial Building $200 (W` <br /> Accessory Structu rlAddition to Acc.Structure 5150 Accessory Siructme or Bud:hDuse $250 <br /> Accessory Structure-Commercial Cl&11 5200 Addition to Accessory SnuctureCommercial Cl&Il $200 <br /> Deck/Stims/Patios S125 Gazebo(WI Stat 59.692 lv 5350 0 1 <br /> Camping Unit 5100 Filf 5150 -Z Q� <br /> Permit Extension Valid for one ear-Onl 1 Allowed $100 <br /> o <br /> *NOTE:Ager-the-fact(when no permit is obtained prior to construction)is throe times the normal fee. y, <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 landsca in ,relaininx walls. <br /> o � � <br /> z <br /> _ 1 0 <br /> Applicant's Name:�� <br /> Applicant's Mailing Address: SSS Or',Jt; AQa,1etN.NI 1V S5� <br /> .p f City T State Zip e <br /> Applicant's Telephone Number: 62 SL 301"t (��0 3 0 " <br /> CD <br /> /� g <br /> Applicant's Email: yv\frr-?eCtC�CS 9L �GltylLtt, L Yl o <br /> a � <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. G <br /> .n 1L'�_ (]Letter Phone Email $ 1 <br /> W SU <br /> Legal Description: gait4)oLJ LAkt? L6� e24 j <br /> Lot#: &'W CSM Vol. Pg. OR <br /> Lot#: Subdivision Name: OR 1 <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#:-S I(o Town#:TI_n N Range#: Rt�O W Town of.. 0&k�n 1 1 <br /> 'Attach additional page if needed for lengthy description OR attach a copy ofthe deed <br /> Parcel#(24 digits):_ h�l— oat Go <br /> Tax ID#(1-5 digits): is 1 13` x <br /> Property Site Address#: _ Q <br /> Road Name: PCA oc L� �OZAA City: <br /> TYPE OF PERMIT(S):Check appropriate box/boxes Fee Rec .� <br /> Single Family Dwelling 13 Multi-Family Dwelling ❑Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑Dedc/Pabo ❑Commercial Addition <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑Bunkhouse ❑Commercial Acc.Structure Q <br /> ❑ Permit Extension ❑ Gazebo—WI Stat S9..6692(ly) ❑Camping Unit ❑ Commercial Acc.Addition C <br /> Proposed Structure/Addition Use: ��i ✓i Z <br /> (HomSe/Cabm;Commercaial Business;Bedroom;Deck etc) <br /> E � NZ 1Building Contractor: i& L-%, T VI 1, �yr �!C== <br /> whi G)®OlpV� 51��Anticipated Start Date: 'r�7+ <br /> Page 1 of 4 C <br /> Burnett County,WI Land Use Application—Rev 3/2015 <br />