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LAND USE PERMIT APPLICATION — Burnett Count, «'I M b <br /> y. <br /> N <br /> Permit Fees: d <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Ci &II) $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> 70 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat59.692 lvp $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $1o0 S <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 /> */tems not listed above will be treated as accessory structures,such as:pergolas.landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> � /� z <br /> Applicant's Name: t C-iK {+ ��r e C�A `� 1 <br /> Applicant's Mailing Address: L VW 44,CA Pttu {til n/ 119 <br /> City State zip I b <br /> 3 <br /> Applicant's Telephone Number: _(q - 3 0 3 ' 700(0 c H <br /> r G <br /> I /�p1 I a J <br /> Applicant's Email: t-i�r �6 nLGI�'fe_�,t LOt,t o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. U) <br /> ❑Letter ®Phone ®EmailCA <br /> N °o <br /> Legal Description: 'S <br /> Lot#: CSM Vol. Pg. OR o d <br /> i <br /> VV <br /> Lot#: Block#: Subdivision Name: OR W <br /> Gov't Lot#:- OR 1/4 1/4 O o p <br /> Section#:_ Town#: y o n1 N Range#:__Lt�_ W Town of: J c,.c r t/1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 �r <br /> Parcel#(24 digits): 07 - 01? -01 -S —d5- -001 - 0.21000 w <br /> Tax ID#(1-5 digits): z <br /> Property Site Address#: 2rf 2Ct <br /> Road Name: ra rj City: Tor�64 <br /> g V <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 ❑ Deck/Patio ❑ Commercial Addition N <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-I WI Stat 59.692(ly) El Camping Unit L3 Commercial Acc.Addition C <br /> Proposed Structure/Addition Use: C t v\ - a el d A ,) - 1. 11 L= s �- > Z :C, <br /> (Home/Cabin;Commercial Business,Bed m,Deck;etc.) *4 M <br /> Building Contractor: n ego <br /> O -� <br /> Anticipated Start Date: am a v/ 4 C o <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 4/2015 D �� <br /> s <br /> z <br />