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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> a <br /> <' b <br /> Permit Fees: 5 IP vi <br /> Dwelling/Principal Building-Single Fami ly $300 Addition to Dwellin Princi al Building-Single Family $200 n <br /> d <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading Filling/Grading $15o »" <br /> Permit Extension Valid for one year-Only I 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 /> *items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> b <br /> m <br /> Applicant Complete All Sections Below This Line <br /> z <br /> Applicant's Name: fit/,6 ,.Q S S' /,1 0 <br /> 47 <br /> Applicant's Mailing Address: D y5 f/ �,� /'� �,t ve e �itd v e <br /> City State Zip ni <br /> Applicant's Telephone Number: � 6.5/-y5 e7-�p Y6 c �j,2 -7£r0 _ 36 < <br /> Applicant's Email: LOe 2 CO !Z c <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter ro <br /> ❑ ❑Phone ❑Email N <br /> Legal Description: dO f' /C-"/W t/,73 /-;' 7 � `3 9�0?3�) leo✓ �ofS w <br /> Lot#:_6:E1 CSM Vol. Pg. 9 OR a a�yPGS M b <br /> Lot#: _Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 y f <br /> Section#: Town#: N Range#: W Town of. 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): O �- O U rs' - - 3 Fs -/y -Oe?-S O S 00 S- O/.?Oo 3 <br /> Tax ID#(1-5 digits): 3-Z 5-1/ r Z <br /> d <br /> N <br /> Property Site Address#: oZ yd yq/ <br /> Road Name: /O r/u P T -C G� lP City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ;K Deck/Patio ❑ Commercial Addition a <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> W <br /> Od <br /> 13Permit Extension E3Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commec:ercial Acc.P�cidition 2�� <br /> Aft co, <br /> Proposed Structure/Addition Use: /feA,-,Id r e �S�/6 t/����j !/i,­z�4 L6 a N Z C <br /> (Home/Cabin;Commerci l Business;Bedroom;Deck;etc.) � O G'7 <br /> Building Contractor: Z Z n o0 0 <br /> A0O <br /> 0 <br /> Anticipated Start Date: /��/S� m C v, <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 ; C� <br /> 3 <br /> x <br /> M <br /> a <br /> m <br />