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�t <br /> LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> N <br /> Permit Fees: a <br /> 6 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single family $200 p 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 Ace.Structure $150 Bunkhouse $250 9 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(C I &11) $200su <br /> o <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(ly)) $350 n <br /> 0 <br /> Camping Unit $100 Filling/Grading $ISO < <br /> r <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> *,NOTE: Aftcr-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application farm,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. — <br /> 'AAWd�_ .. _ o _ <br /> ltl. N> t1 ', (W o <br /> AA �� _ z <br /> Applicant's Name: AT hA G, )I t r <br /> by to <br /> Applicant's Mailing Address: �131� �>tJGt� Ig41 L� p141,0( IIAl a <br /> City State Ztp v -o <br /> Applicant's Telephone Number. <br /> 65 1 - 20-671}J W 6, - 7717 7(L� o <br /> Applicant's Email: A A2;o;T 2 eY410,,Mal -LOA <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter E&hone ❑Email p N <br /> Legal Description: 740TS 11 t �� _ (J (-.4F1 y �t Ihe5 �' L <br /> Lot#: CSM Vol. Pg. OR U) <br /> Lot#: ( +l r Block#: Subdivision Name: L o FTS/ LIP)o R+lt= OR 0 <br /> Gov't Lot#: OR 1/4 1/4 o l <br /> LL <br /> Section#: Town#:__ql_N Range#:_J _W Town of: 'j Ing+5") 70 <br /> *Aflach additional page ifneeded for le" by description OR attach a copy of the deed OR attach tax system property page- <br /> L-oT I <br /> SY <br /> Parcel# (24 digits): 0- 3o j y �OUo .4, <br /> i,,.i it LU y <br /> Tax ID#(1-5 digits): ��7 z S i <br /> Property Site Address#: L i l __ _ _ . ONO <br /> OG C_ <br /> Road Name: City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:[5407) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition ' <br /> z� <br /> ❑ Stairs *11 Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> O Permit Extension O Gazebo-WI Stat 59.692(ly) ❑ Camping Unit LJ Commercial Acc. Addition <br /> n <br /> Proposed Structure/Addition Use: -Ayl �/,�1- a I-A�� — fl <br /> (HomeCabin;Comme�ess;Bedroo n Deck;etc.) <br /> 1 � t� <br /> Building Contractor: <br /> 1� - <br /> N <br /> Anticipated Start Date: !f �/ lip <br /> Page 1 of 4 070 <br /> Burnett County, WI Land Use Application—Rev 1/2016 <br />