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LAND USE PERNUT APPLICATION—Burnett County, WI <br /> s =� <br /> Permit Fees: <br /> u <br /> DwIligglPrincipal Building-Single Family 5300 D Addition to Building-Single Family $200 a <br /> Building-Multi-F 5300 I Addition to Dwe ' -Multi-Family 5200 <br /> CommarciaU xhistrial Building S300 Addition to CommecciaVlndiistrial Building $200 �0 <br /> A Strucaar/Addition to Acc.Stntcture $150 Bunkhouse $250 <br /> O <br /> Accessory Shncduo-Commercial(Cl&Il) $200 Addition to ACOMOTY Stn hire-Commercidl Cl&Il 5200 <br /> DecklStmrs/Pdtios 5125 Gazebo Stat 59.692 lv 5t5Q <br /> camping Unit <br /> $100 F' $ySp <br /> Permit Exteasi®(Valid for one year-Only 1 Allo Sloe o <br /> *NOTE:After-the-fad(when no permit is obtained prior to construction)is three times the normal fee. <br /> •Communication Towers&Signs require a different application form,see correspondtng application and fees. <br /> *Items not listed above will be heated as accessory structures,such as:pergolas, londycaping,retaining walls. <br /> o <br /> a <br /> Y <br /> s 3_ <br /> z <br /> Applicant's Name: RNW)Y A M IC.H LLL 11121MC-,V7--$ <br /> Applicant's Mailing Address: 'AL1,p�X 12 DANIW9,Y W1 5958 Q f� <br /> City State Zip to <br /> Applicant's Telephone Number: 651-2-10-C4-77 0 <br /> m � <br /> Applicant's Em �7ail: r-5R)0C E 5 2-1122_60 C bAI L- COM r^�y <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. �, 1 <br /> ❑Letter []Phone mail ro 00 <br /> Legal Description:I-DT 3 CSM V I 1 F ll DUT t-lYTS �s M y AA??CG(SW 5' <br /> Lot#: CSM Vol.--Lj_Pg.��_ OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:-OR-1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: ° <br /> 'Attach additionalpage ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.• y <br /> -IrStE /lc1TAcH�D <br /> Parcel#(24 digits): 07'DZ.O—2--!j - rn_ <br /> Tax ID#(1-5 digits): 12.C16'7 n a <br /> Property Site Address#:.—7-56(�_ (DAu.LA WI MWl`lS}} <br /> Road Name: )4Y i--,V lA LAKE 90Ar-�, City: tAN5UZY <br /> E <br /> M OF PERMIT(S):Check appropriate box/boxes Fee Rec.J <br /> Single Family Dwelling Ll Multi-Family Dwelling ❑Filling/Grading LJCommercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addibon <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> Proposed Structure/Addition Use: <br /> (Home/Cabbt:Commercial Bminear;Bedroom:Deck:etc.) cJ� <br /> m <br /> Building Contractor: ELvF L� <br /> Anticipated Start Date: IC)I 1 J 5- n N C rpt U <br /> Page 1 of 4 C <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br />