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LAND USE PERMIT APPLICATION- Burnett County, WI a _ <br /> y 1�+ <br /> Permit Fees: to <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin Princi al Building- 'Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 O <br /> AccessoryStructure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> AccessoryStructure-Commercial Cl &11) $200 Addition to AccessoryStructure-Commercial Cl &II $200 <br /> 15� 9j <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c 1 <br /> Camping Unit $100 Filling/Grading $150 _ <br /> Permit Extension Valid for one year-Only I Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '— <br /> m <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. ,2 <br /> Applicant Complete All Sections Below This Line �. <br /> __ ,,.tt z <br /> Applicant's Name J [.1 fir'l d �Tri-&�u� <br /> 1 <br /> 50 <br /> Applicant's Mailing Address: 55r 11E, <br /> City State Zip <br /> PP P 1� 3 J-41 G �- <br /> Applicant's s Tele hone Number: <br /> Applicant's �`t's Email: ! c <br /> PP a.�(�r'l-4-YC�CTY-l f'�P�r�- YYl S i�l � C Z�M 7K' _o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑LetterPhone ❑Email N °C <br /> TS 1 o I ) 91 ACK I ath¢rH Ku C o 's, 1 <br /> Legal Description: �6 �� �blt.�ks Sub � Deli/3 LLhG 2G �n 33� � <br /> Lot#: CSM Vol. Pg. OR LL tt� 1 pp O N RIbW o <br /> Lot#: I )9L Block#: Subdivision Name:A/&/'*Au�IRt k 5J6 eT&';A OR � <br /> Gov't Lot#: OR 1/4 1/4 ( V 1 E I <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system propertyPa e.* y <br /> t <br /> Parcel#(24 digits): O I ��rtt��7�" ���JJ^� 15, 015-oa3 eoo 1 <br /> 3 z <br /> Tax ID#(1-5 digits): 314 d <br /> Property Site Address#: P 151 '.1 _ <br /> Road Name: gay f City: �� W <br /> f T <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Req Oa <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building 9i <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension �( Gazebo—WI Stat 59.692(ly) ❑ Camping Unit O Commercial Acc.Addition z <br /> C 0 <br /> Proposed Structure/Addition Use: CJS Z o <br /> (Home/Cabin;Commercial Business,Bedroom;Deck;etc.) lV M <br /> Building Contractor: 1� <br /> IV � <br /> Anticipated Start Dater n._,I �( �� (7, <br /> Page 1 of 4 6 <br /> Burnett County,WI Land Use Application —Rev 4/2015 <br /> 3 <br /> o <br /> x <br /> m <br /> F <br /> m <br />