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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> LN <br /> < �U <br /> NK <br /> Permit Fees: g th <br /> a <br /> Dwelling/Principal Building-Sin a Family $300 Addition to Dwell' ci al Building-Sin le Family $200 a <br /> DwelfinOrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 °^ <br /> 0 <br /> Commercial/Industrial Building $300 Addition to CommerciaYIndustrial 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 /> A <br /> Deck/Stairs/Patios $1251 Gazebo(WI Stat 59.692(ly)) $350 <br /> Camping Unit $100 Filling/Grading $150 '< <br /> Permit Extension olid for one eaz-Only 1 Allowed) $100 rr', <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: er olas,landsca in ,retaining walls. <br /> 'v <br /> Applicant Complete All Sections Below This Line <br /> � z <br /> .t <br /> Applicant's Name: 1)ovn 4-M r/ r V <br /> Applicant's Mailing Address: R ct? Jaa,,J X- e C4..6r'a(c„e YVL CSW% O <br /> 00 <br /> City State zip Cn p0 <br /> Applicant's Telephone Number: 74 3 306 - 5�/�/offit <br /> o <br /> Applicant's Email: L./,/VAyfa& (D `fffKa91 Cdr �DON/1IDo 9EYt�®,41c1N� . v <br /> p .tel <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone $Email N <br /> oro, <br /> Legal Description: ' <br /> Lot#: CSM Vol. 1 Pg. 1&3- 187 OR g LA <br /> 3 <br /> Lot#: Block#: Subdivision Name: OR = y 1 <br /> Gov't Lot#:—OR 1/4 1/4 J <br /> Section#: "?4j Town#:__39 N Range#:_j_$ W Town o£ woJ ae•— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): 32233 <br /> Property Site Address#: h <br /> Road Name: 0 n, K-0 M, City: (10A <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recsmz2D <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 2 <br /> ❑ Stairs ❑ Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension 13 Gazebo-WI Stat 59.692(ly) L3 Camping Unit ❑ Commercial Acc. Addition z C <br /> n Z D <br /> Proposed Structure/Addition Use: a N m <br /> ome/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> nn � z Z cry <br /> Building Contractor: 4e,4 Icl�� — l rd h}1JP.. /111/1111c 1)����� A Z00 <br /> m 0 o <br /> Anticipated Start Date: Z)ISIS m Z <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 a <br /> x <br />