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LAND USE PERMIT APPLICATION —Burnett County, WI a ro <br /> Permit Fees: to <br /> a <br /> Dwellin rinci al Building-Single Family $300 Addition to DwellingiPrincipal Building-Single Family $200 C7 J <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to DwellinglPrincipal Building-Multi-Family $200 I <br /> Commercial/Industrial Building $300 Addition to CommercialAndustrial Building $200 cv� <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11 $200 Addition to Accessory Structure-Commercial(CI &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat59.692(lv)) $350 0 <br /> Camping Unit $100 Fillin Gradin $150 <br /> r <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 ° <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> ro <br /> n <br /> Applicant Complete All Sections Below This Line <br /> r� o <br /> Applicant's Name: QL4 k S b'c'-C E' 06' <br /> Applicant's Mailing Address: 79S'0 <br /> /4 <br /> 60 I-AA'e (,tJQ�2St�e�' GJI 311893 <br /> City State Zip a <br /> Applicant's Telephone Number: 7/ 57- 8'6& —L573 17 o c <br /> g, v <br /> Applicant's Email: S f isC rtg 1e_;'%UrtCL res d!7$pho0, CQm C7 <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b <br /> ❑Letter JgPhone ❑Email c 00 <br /> Legal Description:ZZJ 7 '6asi IOZ;? CX C5✓» V /D X05 &!CKC <br /> Lot#: CSM Vol. Pg. OR d <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#:_ N Range#: '7 W Town of: [/42/ -V� ) U I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t I <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits):�.S/97 w z <br /> N <br /> Property Site Address <br /> Road Name:Tev&Ae(/ �� City:az moi_ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�s� 0 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> (A <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(Sv) L3 Camping Unit L] Commercial Acc. Addition ? C <br /> M cn ��- <br /> Proposed Structure/Addition Use: CtarcLyN Z m <br /> (Ho /Cabin;Commercial Business;Bedroom;Deck;etc.) m Q f17 <br /> v <br /> � ZAm <br /> � 11ut1 <br /> Building Contractor: Z 0 e=� <br /> X50 N <br /> O <br /> Anticipated Start Date: ©0-+ / 1J Z <br /> Page 1 4 <br /> Burnett County,WI Land Use Application—Rev 4/200 15 <br />