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CA <br /> LAND USE PERMIT APPLICATION—Burnett County, WI �p I!* <br /> � ro <br /> Permit Fees: to <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwellin inti al Building-Single Family $200 ty ` <br /> Dwelling/Principal Build' -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 Ace.Structure $150 Accessory Structure or Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory Structure-Commercial Cl&I1) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(ly $350 <br /> 0 <br /> Camping Unit $100 Filling/Grading <br /> $150 <br /> Permit Extension(Valid for one year-Only I Allowed) $100 a <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's Name: ( ! I e rn&6 4 7rl-P-bp-e C a rU w o <br /> Applicant's MailingAddress:7/43 IDS- St 5w � L1�2YTt1! �fr✓ IrtN* y,�� `d <br /> )4 � � -7– City ' State Zip ro <br /> Applicant's Telephone umbe��3�__��� \� !h '71J -t�Eh–'t< o <br /> �/ J c� <br /> Applicant's Email:746L_►-U�d r h� a Y-"CI-i.`I 1 Lo/y, <br /> i g <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ocsff <br /> ❑Letter Phone []Email <br /> 0 <br /> Legal Description: UQ <br /> y <br /> Lot 4: CSMVoLLq_­Pg.,54 PW-R ,C171-3 V110,2402- <br /> Lot <br /> 110,24 2-Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: Z _OR 1/4 1/4 < I— <br /> Section#:J-i--Town —N Range#: W Town of: J f l � I}� <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed. <br /> Parcel#(24 digits): a l g _ �b /7 '1 1 a ©��"L)L)��0/1 to r CD I <br /> Tax ID#(1-5 digits): <br /> Property Site ddress#: 12B� 71� <br /> Road Name: /U',, rL 0 OL City:1�1�b s i Q r <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: � <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading Ll Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑Stairs 1�1 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazetboj–WI Stat 59.692(ly) El Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: SAra� Ae(L1 C <br /> ome Cabin;Commercial Business;Bedroom;Decketc.) Z � <br /> Building Contractor: ' M <br /> Z <br /> Anticipated Start Date: 20 t� <br /> Page 1 of 4 O Co <br /> Burnett County,WI Land Use Application—Rev 3/2015 Z <br /> L..�J <br />