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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> N y N <br /> Permit Fees: a <br /> a <br /> Dwelling/Principal Building-Single Family 53110 Addition to Dwelling/Principal Building-Single Family 5200 1 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Budding-Multi-Family 5200 -5 <br /> Commercialllndustrial Budding $300 Addition to Commercial/Industrial Building 5200 O <br /> Accessory Structure/Addition to Ace.Structure 5150 Bunkhouse 5250 <br /> Accessory Structure-Commercial Cl&U) $200 Addition to Accessory Structure-Commercial Cl&II $200 <br /> Deck/Stairs/Patios 5125 Gazebo Stat 59.6921v $350 c I <br /> e <br /> Camping Unit 5100 Filling/GradingFilling/Grading $150 I <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed 5100 R <br /> *NOTE:Atter-the-fad(when no permit is obtained prior to construction)is three times the normal fee. rn <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 /> 0 <br /> Applicant Complete All Sections Below This Line S . <br /> 114 <br /> // z <br /> Applicant's Name: (,(JA YN I (-1f>►-V S o ti <br /> Applicant's Mailing Address: ty3 $8 TR o U t' Spe/Nb 4Ay AbAlAX 101 SYS.3 O <br /> City State Zip ro <br /> Applicant's Telephone Number: 71s .2&"g - d Y 7 7 2 " <br /> e <br /> Applicant's Email: kt NAd!WU) P0T&7d;L- C,01n <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter []Phone Email 0 1 <br /> Legal Description: w Q <br /> Lot#: CSM Vol. Pg. OR d <br /> g. I <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 c <br /> Section#: Town#: N Range#: W Town of <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system propertypage.• -j 1 <br /> Parcel#(24 digits): Q 7 O/� - e2' `/o- /S-/S'-S- /S- 7sy- O S/O 06 r <br /> Tax ID#(1-5 digits): <br /> N <br /> Property Site Address#: y3 <br /> Road Name: -R611T S P.AJ IV 6- 4)-AY City: PAM BVA Y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I S O co <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ro <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition r <br /> ❑Stairs Aa. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Atx.Addition <br /> Proposed Structure/Addition Use: CT A/Q R Q E <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: R /Q Cod)677k /C 7-ted A/ O Z D <br /> Anticipated Start Date: —79 /)7,9 <br /> Page 1 of 4 1 <br /> Burnett County, WI Land Use Application —Rev 4/20`5 <br />