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LAND USE PERMIT APPLICATION — Burnett County, WI g b <br /> y � 1 <br /> Permit Fees: ° ~ <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 unkhouse $250 <br /> Accessory Structure-Commercial Cl &Il Addition to Accessory Structure-Commercial Cl&II $200 <br /> Deck/Stairs/Patios $125 1 Gazebo WI Stat 59.692(Iv)) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 °r <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. <br /> Applicant nn CiComplete All Sections Below This Line <br /> L " o <br /> Applicant's Name: ' /' I e.f C K�. IYL <br /> Applicant's Mailing Address: 7 d Z. 4 S L16 5-i'• N1 o A tv—J A(2 114N 5 5 I Z$ <br /> City State Zip 9 <br /> Applicant's Telephone Number: 651- Zo9 - 2 S 45 <br /> c G <br /> Applicant's Email: M,D e C IC E/' e- i'V1 M M• Com d ,19L) <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. .. <br /> ❑Letter b <br /> ❑Phone ,Email N <br /> 0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR <br /> I <br /> Gov't Lot#:_Q0 OR 1/4 1/4 1 0 <br /> J <br /> Section#: ZCQ Town#: 1{p N Range#: �� W Town of A c k$O N <br /> *Attach additional page if needed for lengthy description OR attach a copy of W deed OR attach tax system property page.* y I <br /> t <br /> Parcel#(24 digits): ✓-1 - O 12 -Z-LJO - (5-2 Co ' 05- 00 - O 110 O 1 r. <br /> p <br /> Tax ID#(1-5 digits): 33-%-49 z f <br /> � a <br /> Property Site Address#: 40-14 I jZ <br /> Road Name: Grf-er Rc1. City: l,,t.)EbSTEL " I <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recj 5 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping.Unit ❑ Commercial Acc. Addition (' <br /> Proposed Structure/Addition Use: GW CA C <br /> (Home abin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Q <br /> J <br /> Anticipated Start Date: Au6r• <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> x <br />