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LAND USE PERMIT APPLICATION — Burnett County WI70_ <br /> a <br /> A ^ <br /> Permit Fees: y '-A <br /> A. <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 � C <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v p <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 i E <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial CI &11 $200 j- 1 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 Iv $350 c _J1` <br /> Camping Unit $100 Filling/Grading �. <br /> $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees.*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. 1P <br /> ro <br /> Applicant Complete All Sections Below This Line . <br /> i1 dz <br /> Applicant's Name: n/ /'7. 7 �O t2lJ f/J y r A/-/L 5 %gni /o,Q y _ <br /> Applicant's Mailing Address: .314- 16 <br /> City State Zip r, <br /> Applicant's Telephone Number: 612 , 32-7- <br /> ,7 Z 7• 44 4 ) 5-¢,*3 Q o z <br /> Applicant's Email: sl D /j 3 OGj- y M A ) L- G D !�✓1 '`, 6 <br /> lI' � <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> l ❑Letter hone <br /> w <br /> GO v T L ail <br /> v T 3 $G Tip ❑EmTO yvA-) /d <br /> Legal Description: W '1 <br /> Lot#: CSM Vol.- Pg. 2 15,7 OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:_ OR 1/4 1/4 -7Z E <br /> Section#:6 Town#:�L_N Range#:_�W Town of: 5W) $ S 1 <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page.* ti <br /> PS f f gY P copy Y P P tyPg <br /> Parcel#(24 digits): U 7 O 7 Z/� ��- '�� SAO t� ` 0 5—003 � 01Z-on OV <br /> Tax ID#(1-5 digits): l 2- <br /> 7 y <br /> 3 /4/--6 <br /> N r <br /> m <br /> Property Site Address#: �7 /4/-6 I <br /> Road Name: 5 T A P t E 5 t-A l e-LG ICO . City:� R V 12 y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I,_Z.UO <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> z C <br /> t / n <br /> Proposed Structure/Addition Use:�z!:F/9 B 5l-4 6�-0 /D KZ m <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N 171 -0 t� <br /> 00 <br /> Building Contractor: O L tq &1 G/,4 O 2 y �U1 L f2/144 LL G '�2��/015 Z2 n o <br /> / /3✓i �-OQ�/Z =+ O o <br /> Anticipated Start Date: / �! 7! Z o/ m C o <br /> Page 1 of 4 0 2 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> 9 <br /> m <br /> a <br /> m <br />