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LAND USE PERMIT APPLICATION — Burnett County, WI C <br /> s <br /> N ►- <br /> Permit Fees: a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a (� <br /> Dwellin /Princi al Building-Multi-Family 5300 Addition to Dwellin rinci al Building-Multi-Family $200 V v <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 .P O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 r <br /> Accessory Structure-Commercial C 1 &I I $200 Addition to Accessory Structure-Commercial C 1 &I1 $200 � t <br /> Dee-k/Stairs/Patios 5125 Gazebo WI Stat 59.692 lv) $350 c <br /> Camping Unit $100 Filling/Grading $150 (] <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> *NOTE:Atter-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n �` <br /> *Communication Towers&Signs require a different application form,see correrpr ndtng application and fees. �( <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> rn <br /> } <br /> Applicant <br /> �tComplete All Sections Below This Line r <br /> Applicant's Name:-j I. OM AS 0- f b12 AGes __Y, -k1 A)E- `-- s <br /> Applicant's Mailing Address: Sllef.t.) 101 54917,,l oct�3 <br /> City State Zip <br /> PPTelephone <br /> Applicant's Ntunber: <br /> Applicant's Email: 2 <br /> m O <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. D 0 <br /> 1 0� <br /> ❑Letter [`Phone ❑Email <br /> Legal Description: 4l() sW &)k N 330. 6X $ 030� t <br /> Lot#: CSM Vol. Pg. OR W <br /> s. <br /> Lot#: Block#: Subdivision Name: GO <br /> OR y I <br /> Gov't Lot#: OR 1/4 1/4 £ J <br /> o I <br /> Section#: Town#: N Range#: W Town of. 3)E}1J t L L S <br /> *Attach additional page if needed for lengthy dercnption OR attach a copy of the deed OR attach tax system property page.* y <br /> Parcel#(24 digits): C� 7 -O0� - <� _3 - 19 - 11 - _3 0.Q - Oocy •- X2,1.-0rn o <br /> Tax ID#(I-5 digits): Z d <br /> N <br /> Property Site Address kr� 0 <br /> Road Name:-,S Ltd Fin!SU Pi Zd. City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Re,�W <br /> 18(Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑Deck/Patio ❑Commercial Addition 8 <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure " <br /> ❑Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition �p <br /> r� <br /> Proposed Structure/Addition Use: ylf?M <br /> (Hone/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: AQd S�COO'S4rtA 1 orl e I�� <br /> Anticipated Start Date: <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application - Rev 4/2015 4 <br /> En <br />