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LAND USE PERMIT APPLICATION - Burnett County, WI a c <br /> 0 y <br /> Permit Fees: % <br /> � a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil $200 0 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $30 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $15 Bunkhouse $250 E <br /> m <br /> AccessoryStructure-Commercial(Cl &11 200 Addition to.Accessory Structure-Commercial CI &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Fillip Gradin $150 <br /> Permit Extension Valid for one year-Otfly 1 Allowed $100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. r <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 /> Applicant Complete All Sections BelowThisLine <br /> Applicant's Name: C4Rl/ * Y'/1 e/t-feC/ i9a' z <br /> cC, /J o <br /> Applicant's Mailing Address: ✓ !aQ `V`?OH'74 S 1 CJ �U AVAI - <br /> City 1Wp1_5 State Zip , <br /> C la - z <br /> Applicant's Telephone Number: �6O-Ss9 O o n <br /> a <br /> Applicant's Email: p ` <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> ❑Letterr�� Phone Entail N °G <br /> Legal Description: 1i 407 La a Y C!r a' <br /> d 1 <br /> Lot#: CSM Vol. Pg. OR y <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 Q f i <br /> Section#: �_Town#:_ T_N Range Town of: eC•r.-i A.. ` I <br /> *Attach additional a e ifneededfor lengthy description OR attach a copy oJthe deed OR attach tarsYstem propertypage.* y <br /> Parcel#(24 digits): �7 �DJ8-2"39'f�o"�lo-S ��� O 93-D30000 u) <br /> / z <br /> Tax ID#(1-5 digits): le(yzf <br /> y <br /> Property Site Address#: (01/;!r3 y <br /> ,y�, / � C9 <br /> Road Name: ///td %ow 4,1 /SG2. City: . 1,A01f,y W-r- <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Angle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> °m <br /> ❑ Stairs ,Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N � <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition �C <br /> Proposed Structure/Addition Use: Cna r'A yz �U <br /> az D <br /> ome/Cabin;Commercial Business:Bedroom;Deck;etc.) <br /> Building Contractor: FR <br /> C== <br /> ee n <br /> Anticipated Start Date: pvx yA11D re,nI yam, C <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 4/2015 > -] <br /> M <br /> A <br /> M <br />