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IV 171 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> N N1 <br /> Permit Fees: In U <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 ^4 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial CI &Il) $200 Addition to Accessory Structure-Commercial CI &Il) $200 <br /> Deck/Stairs/Patios 4-1 <br /> 12Q Gazebo WI Stat 59.692(lv)) $350 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year-Only l Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <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. <br /> b <br /> Applicant Complete All Sections Below This Line S <br /> tri n �. ©X � z <br /> Applicant's Name: (� , /�� ',�y Oil c <br /> Applicant's Mailing Address: ,Q !Q I-f' �e� r,`Y) e �ra t ( �I/�j Lkr , W!5'{d3 p IN <br /> City istate Zip W 9 <br /> '115- � �� - 305 < _ <br /> Applicant's Telephone Number: c -So y <br /> (� <br /> Applicant's Email: e r I n --} l O® Q ma 1t c-a 19'1 <br /> d <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Lettertl0 <br /> ®Phone ❑Email <br /> Legal Description: ID 5014 RC-8 Pi e-Tmi 1 2. <br /> Lot#: CSM Vol. Pg. OR 1 <br /> Lot#: �Block#: Subdivision Name: PI he W 13 0A 6111+0410KOR <br /> Gov't Lot#: OR 1A 1/4 o <br /> Section#: Town#: N Range#: W Town of: 0 1t11 o Y1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> J <br /> Parcel#(24 digits): d�-034i-.Z—�o �l�-30 -5 15- 5$5-oa3000 <br /> Tax ID#(1-5 digits): r' z <br /> Property Site Address#: <br /> Road Name: e t h e r A ICity: Dan btkr u <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recxl O <br /> 'd Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ''Single Family Addition ❑ Multi-Family Addition ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> p Ho me beck Acid I or, C) <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) "n <br /> (J0 <br /> Building Contractor:_ IlOC� 1 ' $ors t <br /> a / - <br /> Anticipated Start Date: m v <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application —Rev 4/2015 <br /> a <br /> S <br /> M <br /> A <br /> M <br />