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LAND USE PERMIT APPLICATION- Burnett County, WI ZIN b <br /> Permit Fees: s <br /> Dwelling/ incial3uildin -Single FamilAddition to Dwellin rinci al Building-Single Family $200$300 '• <br /> Dwellin !Princi al Building-Multi-Family 0 Addition to Dwelling,Principal Building-Multi-Fumily 5200 <br /> n <br /> Commercial/Industrial Building S300 Addition to CommerciaUlnduarial Building 5200 <br /> Accessory Structure/Addition to Ace.Structure S150 Bunkhouse $251) <br /> Accessory Structure-Commercial(Cl&11 $200 Addition to Accessory Structum-Commercial(Cl&1I $200 <br /> ( <br /> Deck/Stairst?atios $125 Gazebu(WI Stat 59.692(1 v)) $350 0 <br /> Camping Unit Sl00 Fillin "Gad <br /> $I50 <br /> Permit Extension Valid for one year-Only I Allowed) I $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. rn <br /> `Communication Tawers&Signs require a diferenr application form,see corresponding application and_fees•. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> v <br /> R <br /> r <br /> Applicant's Name: yo$L ci/ 91 l y t <br /> Applicant's Mailing Address: 2 3 0 4 e u Ave A Ry9; 4r M rl/ <br /> City State Zip 7 <br /> < 4 <br /> Applicants Telephone Number: / o d <br /> Applicant's Email: 4, <br /> / 7 n i �� t�a 1M t 4 57 r21 <br /> _n <br /> Tf staff has a question about this application how do you prefer to be contacted? Check one below. <br /> b <br /> ❑Letter Phone Wtnail <br /> Legal Description: <br /> Lot#:_ CSM Vol. Pg. OR o <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR _ N <br /> Gov't Lot#: OR I!4 1/4 F t <br /> Section#: -Town#: N Range#: W Town of: ' <br /> r � <br /> *-Rtrach additional page ifneeded for lengthy description OR attach a copy of tyye deed OR attach t y s}'stem property page-* <br /> 0.7 0 -,2 -114 -1 b Bo- d? 000a0 0 � <br /> Parcel#(24 digits): O <br /> Tax ID#(1-5 digits): I �e Q� F z <br /> � w <br /> Property Site Address#: O <br /> Road Name: EaJI y e- L 10t.✓ Cl !✓GR !t O City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec3MtOD <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio Q Commercial Addition <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse u Commercial Acc.Structure <br /> J Permit Extension J Gazebo <br /> �y—WI Stat 59.692(iv) LI Camping Unit ❑Commercial Acc.Addition <br /> Proposed Structure/Addition Use: t-' 0 )�,✓t � m <br /> l-i I / (HonwlCabin,Cowmerrial Business:Bednwm;Dh kr eec.) 3%' 0 m W <br /> �-/Building Contractor: Qa l V Yr 6j eA ¢ �=Pyy r� <br /> � � � , N Cc=Start Date: �1�A; .6 e 6 N��f/ o o <br /> a� <br /> Page i of <br /> Burnett County, WI Land Use Application— Rev 4/2015 ' <br />