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• LAND USE PERMIT APPLICATION - Burnett County. WI _ b <br /> a <br /> Permit Fees: a 1 c v, <br /> c <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaUIndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl&I I) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 1 <br /> 0 <br /> Camping Unit $100 Fillin Gradin $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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> ro <br /> Applicant Complete All Sections Below This Line o �. <br /> z <br /> Applicant's Name: 33-p Y A r4 I P S O,4 c <br /> Applicant's Mailing Address: Co 03 Cy WWASM& <br /> City State Zip e <br /> � z <br /> Applicant's Telephone Number: (a 12- Z 8 C) S3 Fj o <br /> G <br /> Applicant's Email: %VG 1 PAYSON S CZ-14411--c-00V d <br /> p <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone ®,Email tl0 <br /> Legal Description: W t 610 #41d 1,)% S7 CJ'f <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 1 f 1 <br /> Section#: S t2 Town#:_r_4 9 N Range#:_jr?__W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* y <br /> Parcel#(24 digits): 0 '7-o/g-1 -J 9 Y6—/j Z - o y-O©p • D/zo g-,O <br /> z Q <br /> Tax ID#(1-5 digits): <br /> N <br /> Property Site Address#: Ce /O 3 <br /> Road Name:—C&u iv r ^ <br /> v AVAb k City: W8,2 S Tei. <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:l�- <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> AL,5tairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension L3 Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit El Commercial Acc.Addition o <br /> � Z ZProposed Structure/Addition Use: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> W C=U <br /> Building Contractor: S WL. C O ^' <br /> Anticipated Start Date: U PW AT PILOYA L, r) C <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application — Rev 4/2015 <br /> 3 <br /> b <br /> s <br /> M <br /> a <br /> m <br />