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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> 6 <br /> W rn <br /> Permit Fees: ►+ <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Budding-Single Family $200 <br /> b <br /> Dwelling/Principal Building-Mind-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 v, <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 v i <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial Cl&11 $200 0 <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692 lv $350 c <br /> Camping Unit $100 Fill' Gradin $150 »' <br /> Permit Extension Valid for one year-Only 1 Allowed $100 c <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:pergolds, landscaping,retaining walls. <br /> �o <br /> Applicant Complete All Sections Below This Line c <br /> z <br /> Applicant's Name: 76Abn�u J7/�( D94 tAK6,0 ) ,t' ,/ /�,` �) <br /> Applicant's Mailing Address: R a� �/7/f/�j �j w /!4w /VIA1 151-3 <br /> City State Zip v ro <br /> Applicant's Telephone Number: 46Z Z:5,6 fp �Sti <br /> Applicant's Email: LW An J(r Ax6aAj 0.1 ,Qi cy/)'I( d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> f ❑Letter ®Phone Email N l <br /> Legal Description: L0T I dh/A VDL!L M6 1419-!49 dAT LOT -/O-/I/ <br /> Lot#:�—CSM Vol._j 2- _Pg. 1"-/tom/ OR d <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 I� 6 <br /> £ Sri D� <br /> Section#: Town#: N Range#: W Town o 1 p <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o) <br /> � r <br /> Parcel#(24 digits): r 1 <br /> � <br /> Tax ID#(1-5 digits): 17 79 Oa8 t? z <br /> Property Site Address#: �2 ��,11 �l <br /> Road Name: LX 1 t.7C� �� <br /> A40L City: 117w4,].t tt 4 <br /> TYPE OF PERMrr(S): Check appropriate box/boxes Fee Rec:__3t7)1?Cn <br /> ❑ Single Family Dwelling ❑ Mufti-Family Dwelling ❑ Filiing/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Mufti-Family Addition ❑ Deck/Patio ❑Commercial Addition y <br /> °m <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse L3 Commercial Acc.Structure <br /> ❑ Permit Extension Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> Proposed Structure/Addition Use: A,//QE p/ n <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: MA 0 <br /> , - . o <br /> Anticipated Start Date: N G/ ate/s C v, <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> m <br />