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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a a c <br /> rn' <br /> Permit Fees: ; <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> rn <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $1501 Bunkhouse $250 l E <br /> 0 <br /> Accessory Structure-Commercial C I &I l) $200 Addition to Accessory Structure-Commercial C I &I I) $200 1 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) L) <br /> $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension Valid for one year.-Only 1 Allowed) $100 ° S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '- <br /> *ltems not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> �+ <br /> 1 _ z U <br /> Applicant's Name: 94ire"vt QL r`1,�ai-eckii: / p <br /> Applicant's Mailing Address: 3 I G IatC 1 of WaL Pas T n!c M 0 cFCms <br /> G City State Zip <br /> Applicant's Telephone Number: &S/—��3— 4�O T.S- o <br /> Applicant's Email: ;4;b&@i V do l Q o Mnatl 1. e4ft p O <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> ❑Letter OPhone O15mail N tl0 W <br /> 0 <br /> Legal Description: S 41(o 1,6e SE <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR r„ ) <br /> Gov't Lot#: OR 1/4 1/4 il <br /> o a <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage. <br /> W � I <br /> Parcel#(24 digits): 07- OHO -2 -3 j-/13 32-r{ o q -Doo —0/3&&C-1 0 <br /> Tax ID#(1-5 digits): Z 7$SS y <br /> y <br /> Property Site Address#: !a2 11$0.3 <br /> Road Name:— e ri I?-r&c R4 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: ' e W <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑,Multi-Family Addition LlDeck/Patio El Commercial Addition <br /> J o <br /> El Stairs Id Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> Ll Permit Extension Ll Gazebo—WI Stat 59.692(ly) El Camping Unit Ll Commercial Acc.Addition ? C <br /> Z �u/,� `a Z <br /> Proposed Structure/Addition Use: �j'QrawO Aadt 10�//Y,�s�dyt bbl D� � <br /> �me/Cabin;Commeri al Business;Bedroom;Deck;etc.) 0 v <br /> Building Contractor: S.e Z 0 N C= <br /> Anticipated Start Date: s/9/�� Z o <br /> Page 1 4 0 �� <br /> Burnett County, WI Land Use Application-Rev 4/200 15 <br /> 3 <br /> •a <br /> X <br /> m <br /> a <br /> m <br />