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LAND USE PERMIT APPLICATION - Burnett County, WI Cr b <br /> Permit Fees: in <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 a <br /> a <br /> Accessory Structure-Commercial CI &II) $200 Addition to Accessory Structure-Commercial CI &[I $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 <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 /> �o <br /> m <br /> Applicant Complete All Sections Below This Line <br /> r'�Air- T�+oMV,5atJ z <br /> Applicant's Name: P <br /> (� r <br /> Applicant's Mailing Address: 1 1T" �-0�o PT)+tL <br /> M/ti/,F0U,57-Y,-, Mt9'T3 <br /> I Q <br /> Applicant's Telephone Number: 61Z S�' 164 lo- <br /> Applicant's <br /> Applicant's Email: SK'H L/•✓EIvN� w` • Gam 1 <br /> d <br /> a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter hone Email 00 1 <br /> Legal Description: S � q - T `f o N — R 1 S W — (7 O N u o-r 1 <br /> Lot#: CSM Vol. Pg. OR o <br /> 1 <br /> Lot#: Block#: Subdivision Name: OR = „ <br /> 1 <br /> Gov't Lot#: OR 1/4 1/4 1 = 1 <br /> Section#: Town#: N Range#: W Town of: O <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 0 �2^ 2 ' �}D —� —1 g '`� ' 001 r OI 2 O 4 0 X <br /> Tax ID#(1-5 digits): S7 4 St <br /> Property Site Address#: ; l(0s y <br /> Road Name: 13u5t4E4 It"R • City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec 3W.Ov <br /> .ZSingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> H <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <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 z <br /> N <br /> Proposed Structure/Addition Use: C Ar.0 t >Hc <br /> � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - Z �C <br /> Z <br /> FriN <br /> Building Contractor: 0 wr/E-YL- 1 <br /> erg <br /> Anticipated Start Date: � ' (6,2�� .1 <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 >5 �-----� <br /> m <br /> F <br /> m <br />