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LAND USE PERMIT APPLICATION—Burnett County, WI g b <br /> Permit Fees: ° <br /> o. <br /> DwellingTrincipal Building-Single Family 5300 Addition to Dwellmgjrincipal Building-Single Family $200 <br /> Dwel' rind Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 (S\ <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 rC <br /> m <br /> Accessory Structure-Commercial(Cl&II $200 Addition to Accessory Structure-Commercial Cl &II $200 p <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 1 <br /> C <br /> Camping Unit $100 FillingtGrading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Sighs require a different application form,see corresponding application and fees. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> 'v <br /> Applicant Complete All Sections Below This Line o • <br /> Z <br /> Applicant's Name: �Dn"ALA G. LiAlIZ50,�-i o <br /> Applicant's Mailing Address: ZSQ 0 L-/ e6A43 �_W$Q <br /> City f State zip o <br /> loll - 3CG' 704-W o N z <br /> Applicant's Telephone Number: <br /> Applicant's Email: N EQtrSaviYE4 �?Lue0..r*� �t✓i4� .YIE?� d <br /> w <br /> m , <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v <br /> Letter QPhoneEmail !. <br /> Legal Description: / � 192 rJI AD D( 7�CV"I -1-0Vo Lj'.464J`?,j11 t_ LAS L l oT 1 2. <br /> Lot#: f CSM Vol. Pg. OR <br /> a. <br /> Lot#: Block#: Subdivision Name: OR a <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: 5C o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1} <br /> Parcel#(24 digits): <br /> 07- DZS-2 -1.10 - / 1.1 - 07 - : /5-- 165-6/1000 r <br /> q <br /> Tax ID#(1-5 digits): 1 3 d n z <br /> rte' <br /> Property Site Address <br /> Road Name: 1<( Lk 6 l2E City: OANO VV-� ( <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition Deck/Patio ❑ Commercial Addition C�7, <br /> ❑ Stairs ❑ Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo— WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 0 Z It n u <br /> Proposed Structure/Addition Use: RV?LAC£. OLD Of 16 t tV A L Q-EG K� r— <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) *P <br /> N <br /> Building Contractor: /t� - R 0 6111 T $T'(c E.I F ir C CPZ � <br /> Anticipated Start Date: AU6 US T- l t Z015" <br /> Page 1 of 4 0 <br /> Burnett County,W1 Land Use Application—Rev 4/2015 <br />