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LAND USE PERMIT APPLICATION — Burnett County, WI G r <br /> a <br /> Permit Fees: a 19=4 <br /> Dwelling/Principal Building-Single Family <br /> $300 Addition to Dwelling/Principal Building-Sin le Family $200 <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &II $200 Addition to Accessory Structure-Commercial Cl &11 $200 <br /> Deck/Stairs/Patios $125 Gaze WI Stat 59.692 Iv) $350 cCn <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-OnlyI Allowed) $100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> o <br /> Applicant Complete All Sections Below This Line <br /> f z <br /> Applicant's Name: -DIANNE C CANAL <br /> Applicant's Mailing Address: /C)SV/ P-IvFiF,4 a Ay 01/,k M Inz,i.bvA-7 4 My 5za , <br /> City State zip <br /> Applicant's Telephone Number: 65/-955-26!;.2, <br /> — a d <br /> ` c � <br /> Applicant's Email: "o/� � e;;pS/, ct rm 0 <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> []Letter ❑Phone ®Email0° <br /> 0 <br /> Legal Description: SEE A7-f4CArZ; <br /> Lot#: CSM Vol. Pg. OR d <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: is( 2- OR 1/4 1/4 / u o <br /> Section#: 2,9 Town#: 4-0 N Range#: 1'¢- W Town of: SC077' ;7V <br /> *Attach additional page ifneededfor lengthy description OR attach a copy of the deed OR attach tax system property Page. y <br /> 07-OU-Z-¢O -/4-2S-S-oS•-Go1-o/3noo O <br /> Parcel# 24 digits): O.1-07.8-.Z-4ti�-!4 -2 5-5'-05 -OU/ -0/46 o p <br /> ( na—nag—Z_—Orr—i'tt-- —:5 6S —B6; <br /> Tax ID#(1-5 digits): j8�i73-j$�79 - 920 6 n z <br /> Property Site Address#: <br /> Road Name: k657 polA/T R<3" City: 50cJ61V <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Z 7S, <br /> ❑ Single Family Dwelling L3 Multi-Family Dwelling ❑ Filling/Grading LlCommercial Building Fee Rec: <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <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 <br /> Proposed Structure/Addition Use: G4A4p Si/�'S y CD� ,�• ,��+��'��� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor: Q M <br /> Anticipated Start Date: .7PXtly,6- moo! 7 <br /> Page 1of4 18 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> S <br /> 2 <br /> A <br /> m <br />