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LAND USE PERMIT APPLICATION-Burnett County, WI Cr <br /> N r� <br /> Permit Fees: a' ut <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin Princi al Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure 10Bunkhouse $250 ` <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial Cl &II $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 I <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only l Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> w <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 /> ^o <br /> Applicant Complete All Sections Below This Line <br /> Z <br /> I <br /> Applicant's Name: � w)i5 S R &ear, <br /> Applicant's Mailing Address: 596 Y J G(�(— CD i N la MN S Srg2& R� <br /> City State zip <br /> Applicant's Telephone Number: <br /> Applicant's Email: Jb�r5w4 @ 49'IAA-1 LM o <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. \ <br /> ❑Letter Phone ❑Email � <br /> av �" <br /> Legal Description: OQ <br /> Lot#: CSM Vol. 2 Pg. /S� OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> O�-o/l "0/60oc7 c' <br /> Pazcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): s7 r <br /> Property Site Address#: Z 6763 <br /> 63 <br /> Road Name:— City: OQh h t/ley <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 1 'z•cci <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> H <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 4 <br /> 0 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition 3 C <br /> Proposed Structure/Addition Use: %D�L S�t;p y Z <br /> C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N 7M <br /> {Z <br /> Building Contractor: tkok F hZL�' Q <br /> AG)o0 <br /> Anticipated Start Date: <br /> Page lof4 0 � C7uuu <br /> Burnett County,WI Land Use Application—Rev 4/2015 > U <br /> 3 <br /> x <br /> m <br /> z <br /> m <br />