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LAND USE PERMIT APPLICATION — Burnett County WI <br /> a <br /> a' - ►e <br /> Permit Fees: ]' Ir <br /> Ir � <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal 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 EL <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> oo <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only l Allowed) $100 � <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is-fy,r times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> ro <br /> lA,,pplicant Complete All Sections Below This Line T <br /> Applicant's Name: ►I ODS\ 1 U Q b Q o <br /> Applicant's Mailing Address: S 7 3�, N o AV, 50. M fjWL_-I —+x 771Q -- - <br /> ! 1 p City State Zip rn ro <br /> Applicant's Telephone Number: b I- l o - ���g E <br /> Applicant's Email: o <br /> d � <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> DO <br /> ❑Letter ]Phone ❑Email t t <br /> Legal Description: E',UN D + S AT t 1t1 RL` S V B CR 1 <br /> Lot#: CSM Vol. Pg. OR o <br /> N <br /> Lot#: 2 0 Block#: L Subdivision Name: OR a <br /> 00 <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: Town#: N Range#: W Town of: o a W� Y 1 7 t <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property <br /> P g f f g Y P crPY .1� Y P P tJ' <br /> Parcel#(24 digits): 0� - 007 ' 2 ' 3$" 1N - I O - 5 (5 - 440 - 03J000 � <br /> � z � <br /> Tax ID#(1-5 digits): 3 i 3 l 0 n W) y <br /> N <br /> Property Site Address#: 8Z 3 <br /> Road Name: S l3 T 6 11 I R L N City: 5 tf F_L L LAKE <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recce <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition A Deck/Patio ❑ Commercial Addition 4 <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> LlPermit Extension ❑ Gazebo-WI Stat 59.692(ly) LlCamping Unit LlCommercial Acc. Addition Zn W <br /> f�. C 0 <br /> Proposed Structure/Addition Use: D-e(,l y Z o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) owl m <br /> c� U u fJ <br /> Building Contractor: V <br /> N <br /> Anticipated Start Date: m o j <br /> PageZ <br /> 1 of 4 c <br /> Burnett County,WI Land Use Application — Rev 4/2015 <br /> x <br /> m <br /> m <br />