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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> 3 , <br /> Permit Fees: n to <br /> Dwellin 'nci al Building-Sin a Family $300 Addition to Dwellin i al Building-Sin e Family $200 0 <br /> Dwell ingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Buildin -Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommercialAndustrial Building $200 _ <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse $250 <br /> n <br /> Accessory Structure-Commercial CI&11 $200 Addition to Accessory Structure-Commercial CI&I1 $200 T— <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 o <br /> n <br /> Camping Unit $100 Fillin Gradin $150 (7'r c' T <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> *NOTE:Aller-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 /> *ltems not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> A C <br /> Applicant Complete All Sections Below This Line o 9. <br /> ' I l� <br /> Applicant's Name: 1 Vit` n D[1A S <br /> Applicant's Mailing Address: Z d l S z y,t-(-t,- L-G y,P 1�l�bf S ���j �11�� ,ae?? <br /> CAI :f L/O City State Zip b '� <br /> Applicant's Telephone Number. 1, ° (q I U Q 1) 6`Y0 <br /> y a <br /> Applicant's Email: t�I f�a t PIS Z�o �� �.r� ai t C o run 'E ' <br /> � O <br /> If staff has a question about this application how doyo prefer to be contacted? Check one below. <br /> ❑Letter Phone []Email N ro <br /> Legal Description: &t-L4 >4 " CF(i 5' � <br /> r" <br /> Lot#: CSM Vol. Pg. OR o u <br /> 4 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 I p_ <br /> Section#: Town#: N Range#: W Town of <br /> to <br /> *Attach additional page if needed for lengthy description OR attach a copy ofthe deed OR attach tax system/property page.* <br /> Parcel#(24 digits): Q 7 -019 —-Z '� 7% ^/5 "-050 S �l_-F�5- b^d/ 6700/ r 00 <br /> ��//�� I^ <br /> Tax ID#(1-5 digits): I OZ Ill D z I <br /> Property Site Address#: I ' - / / of�. <br /> Road Name: !',A/rAke Su{,a�IW�,A ed City: l/VQ k T L r v <br /> � U <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> LJSingle Family Dwelling LIMulti-Family Dwelling LJFilling/Grading ❑ Commercial Building /S-D` <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Q Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition 0 <br /> Proposed Structure/Addition Use: �7r� A tic S v ma c` Fv i 0 10( 1/S L C <br /> (Hamrl in: omnrercid Brciiness;Bedroom;De k etc.) C <br /> I'' n �" o n <br /> Building Contractor: to Z 10+17/A.L � ��C �rlta C'c, �/�ESIv L/ 9 NZ :::0 <br /> Anticipated Start Date: /'I w 0 Z (Cj'If� <br /> Page 1 of 4 0 G)0 r" <br /> Burnett County,WI Land Use Application—Rev 3/2015 Z o <br />