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LAND USE PERMIT APPLICATION —Burnett County. WI a b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil $200 }� <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 JIB <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 W o <br /> Accessory Structure/Addition to Ace.Structure $15 Accessory Structure or Bunkhouse $250 £� <br /> Accessory Structure-Commercial(Cl&l l $200 Addition to Accessory Structure-Commercial C 1&11 $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692 lv $350 0 1 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> -o <br /> m <br /> Applicant Complete All Sections Below This Line o <br /> Z <br /> Applicant's Name: t /"AI�J e <br /> Applicant's Mailing Address: S-ZS C3N6LUu L-- L- J , PLYHo4l Aoi S$-4,+L__ tp <br /> City State Zip <br /> Applicant's Telephone Number: (,o I Z -Z-2-O-Lf <br /> ti <br /> c <br /> Applicant's Email: M ( HAR-KrZA FT_.4Mt-45 v p 1 <br /> d <br /> 9.1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> w 1 <br /> ❑Letter �_ phone ❑Email o <br /> k7 C�iT�ems t <br /> Legal Description: SADA ' <br /> Lot#: CSM Vol. Pg. OR / <br /> / / �A /v� t RQ <br /> Lot#: �' Block#: (O Subdivision Name: �7Fe- Alcl( "ZaG OR „ <br /> Gov't Lot#: OR 1/4 1/4 <br /> � g _ � <br /> Section#: .3 Town#: N Ran e#: W Town of: SG e 1 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24digits): /0-/y-/-3 /5'-�13Z- o6 9oCC <br /> n � <br /> Tax ID#(1-5 digits): l o 6 � d A <br /> Property Site Address#: Al y <br /> Road Name: TZACW� NL_ City: SC-0 j/ <br /> E <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:_ <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> y <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition ti <br /> ,�/ m <br /> ❑ Stairs .�t9.ACC. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure � <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition z <br /> Z 1, <br /> y W <br /> Proposed Structure/Addition Use: s7c) e C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -n M <br /> \ °z Z bo CJ11 <br /> Building Contractor: SLI- (MRalW2t4-r-j tio%-28UtLpt�� 1 K � <br /> bo <br /> Anticipated Start Date: ARZA L 1 tl OR- /t5 -SD0jJ As At»$S i gLjr M Z o up <br /> Page I of 4 c 00 o <br /> Burnett County,WI Land Use Application—Rev 3/2015 Z <br /> X <br /> m <br />