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91 W <br /> LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Crer <br /> e: ro <br /> Permit Fees: to <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwe ' ' ci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/IndustrW Building $200 <br /> Accessory Structure/Addition to Acc.Structure $1 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Stricture-Commercial Cl&II $200 <br /> 1 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692 lv $350 0 <br /> Camping Unit $100 Fill' Gra ' $150 �- <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three Limes the normal fee. <br /> m <br /> *Communication Towers&Signs require a different application form, see corresponding application and fees. 22 <br /> *Items not listed above will he treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> Applicant Complete AllaSeddons Below Ibis Line . <br /> Applicant's Name: R&17 le d`Aeo <br /> - _ <br /> Applicant's Mailing Address: ,2�8z.S— ff�fL /f 4-y 2/ roe7.* <br /> City State Zip <br /> Applicant's Telephone Number: 7 9?2 <br /> d <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. -� <br /> Letter Nflione ElEmail N <br /> 1" <br /> S <br /> Legal Description: OQ <br /> ' l <br /> Lot#: CSM Vol. Pg. OR 9 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 0 i <br /> Section#: Town#: N Range#: W Town of <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> v <br /> Parcel#(24 digits): ` <br /> 1 <br /> Tax ID#(1-5 digits): t� w CJ <br /> Property Site Address#: 3 D <br /> Road Name: T460r L4/ke City: Qti7(JK�y { w� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: .(� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi mily Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ StairsAcc. Structureon-bunk Ouse ❑ Bunkhouse ❑ Commercial Ace. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(1 v) ❑ Camping Unit ❑ Commercial Ace. Addition <br /> Proposed Structure/Addition Use: l�f'.-ti S �� / Z m <br /> Q (Home/Cabin;Commercial Business;Bedmom;Deck;etc.) m -O <br /> Building Contractor. f�f� t'o�f f/'4cf; �• Wi f®/1 Iv� �oo -7j7— y�d <br /> n N <br /> c ¢ /j— O o <br /> 0 <br /> Anticipated Start Date: O / • C <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />