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LAND USE PERMIT APPLICATION—Burnett County, WI aen <br /> y r 1 <br /> y ~ <br /> Permit Fees: 5 to <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 ICS-7.1 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125PGazebo(WI Stat 59.692(l v)) $350 0 <br /> < 1 <br /> Camping Unit $100 Filling/Grading $150 .: r^ <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '- <br /> w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line c <br /> Q <br /> Applicant's Name: yr'0.d '} t--ar r M 0.C,k eo.r1 <br /> Applicant's Mailing Address: 01a�1 to W 000 LAKE Dk C0R1%1J'M5VRBr W1 543W <br /> City State Zip a <br /> z <br /> Applicant's Telephone Number: —I l S (o q — 21; 0 0 o <br /> Applicant's Email: M06.c kton Arn i u @ A rr►gi . co M o <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter JKPhone []Email N <br /> w \ 1 <br /> Legal Description: ' <br /> Lot#: CSM Vol. Pg. OR o <br /> Lot#: Block#: Subdivision Name: OR a <br /> t <br /> Gov't Lot#: (o OR 1/4 1/4 <br /> Section#: 2.5 Town#: 38 N Range#: IS W Town of: W 00 aA 9U V eX t <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system property Page. <br /> Parcel#(24 digits): 07 - 042 -2. - -3$ " 1 $ - 2S - 6 05- 00(, - 013000 <br /> a8`i z <br /> Tax ID#(1-5 digits): 80 � a <br /> Property Site Address#: a la 7 <br /> Road Name: W nO d -.oke- Dr City: G c P n-Vs 6v f q <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building CTYI��t° �2e <br /> ❑ Single Family Addition ❑ Multi-Family Addition 8 Deck/Patio ❑ Commercial Addition 6 <br /> JR Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> LRn <br /> Proposed Structure/Addition Use: 40 Me_ � Pa_'�la a Z C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -fin N Z <br /> Z <br /> Ila <br /> Building Contractor: O A T H S $iZOTF4ER5 Go N ST. - S 1-F14'D�TREE I-AI�DSCAPI z <br /> 2 N <br /> Anticipated Start Dater Uq u S f I t{ 'TONE 20 l SLn <br /> Page 1 of 4 < U u t1 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> b <br />