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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Permit Fees: ] to <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 �;Z O <br /> Dwelling/Principal 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 C1 &Il) $200 Addition to Accessory Structure-Commercial Ci &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692 lvp $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> 0 <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. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> 'v <br /> Applicant Complete All Sections Below This Line o �. <br /> p z <br /> Applicant's Name: A�.�IE 71E.44bEfr. i„ <br /> Applicant's Mailing Address: 10&3A`j IF11EAbbVA 3`r 114 FtA44ja /6th W <br /> CityState Zip �i <br /> PP P %5171 ZS63 . C' (a Z. gfoS Z7 '-1-1 a z <br /> Applicant's Telephone Number: — — -� <br /> c <br /> a � <br /> Applicant's Email: O1,�1.t, (,. ,_, t7 A.p(„ <br /> iD <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> 'o G <br /> ❑Letter 'hone ❑Email <br /> Legal Description: so -Z, <br /> -- <br /> Lot#: ' CSM Vol. jr Pg. Zf !7 OR 2-(0 tl RCT ZT <br /> y <br /> n <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1A 1/4 F j <br /> 0 <br /> Section#: Town#: N Range#: W Town of: � 1 <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page.* <br /> * H <br /> P 8 .f f 8 Y P PY .f Y P P t1'P 8 i <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): z d <br /> N <br /> Property Site Address#: <br /> Road Name: SyKCity: 45rP-o4044JEQ� �1• <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 1 <br /> C <br /> C3 Stairs Acc. Structure(Non-bunkhouse) L3 Bunkhouse ❑ Commercial Acc. Structure N C <br /> LlPermit Extension E3Gazebo-WI Stat 59.692(ly) ElCamping Unit LICommercial Acc. Addition Z Z n -..1. <br /> Proposed Structure/Addition Use: 4*-—AJ44T= U-1 <br /> m <br /> 0 K <br /> (Name/Cabin;Commercial Business:Bedroom:Deck:etc.) Cry <br /> N <br /> Building Contractor: 0 o <br /> C En <br /> Anticipated Start Date: n <br /> Page 1 of 4 o C� <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> a <br /> m <br />