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LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> y 'r <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil% $200 O <br /> DwellinglPrincipal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 v <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building 5200 o <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse 5250 1 E <br /> Accessory Structure-Commercial(Cl &II $200 Addition to Accessory Structure-Commercial Cf &[I) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(1 v)) $350 0 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> t- <br /> Permit Extension Valid for one year-Only l 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 fee.+. = <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining wall.,. Z <br /> Applicant Complete All Sections Below This Line a <br /> �//� ll ypz <br /> Applicant's Name: c�f. o rr N."e-ok /L 05Sp t✓ Em <br /> Applicant's Mailing Address: 6 6-3 8- n Ad A 1, 66:5k4- 40.' 5'�"3 <br /> City State zipUl <br /> Z <br /> Applicant's Telephone Number: 7/s <br /> Applicant's Email: S kvr_�1161So to �,y hoo. C a <br /> V O <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letterhone ❑Email 17e`, <br /> Legal Description: 17 W AJ U1'5h 2 W kc5MT_ E 33' w sv� <br /> Ul <br /> Lot#: CSM Vol. Pg. OR <br /> N <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> 7 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* ti <br /> Parcel#(24 digits): 07- 01 te-)_- 39 - 1'7 - A4 - 3 02, -000 - ©1(000 <br /> x <br /> m <br /> Tax ID#(1-5 digits): 0 7 q z <br /> y <br /> Property Site Address#: <br /> Road Name:—C<-., 9d b City: /, e- r>✓9 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec,-LJ , <br /> 0 Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition H C Q <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 0 R1 z <br /> Proposed Structure/Addition Use: a-ire� o <br /> (Nome/Cabin;/Commercial Business:Bedroom;Deck:etc.) 0 N C=3 <br /> Building Contractor:��jt [. S[3� C�C>�S� "' <br /> Anticipated Start Date: 7 <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 9 <br /> 2 <br /> M <br /> M <br /> M <br />