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3D° o0LAND USE PERMIT APPLICATION —Burnett County, WI C r <br /> Permit Fees: ' $ <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingRrincipal Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory StructurelAddition to Aoc.Structure $150 Bunkhouse $250 <br /> m <br /> Accessory Structure-Commercial C 1&I1 $200 Addition to Accessory Structure-Commercial C 1&I I $200 <br /> Deck/Statrs/Patios $125 Gazebo WI Stat 59.692(l v $350 0 ` <br /> e <br /> Camping Unit $100 Fillin Gradin $150 <br /> r <br /> Permit Extension Valid for one year-Only 1 Allowed $100 ° <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. } <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. 7 <br /> .9 <br /> c <br /> Applicant Complete All Sections Below This Line N <br /> (Rt 'k Ot,SotJ <br /> Applicant's Name: <br /> Applicant's Mailing Address: J0/6' 150A 5rz /c1 . %5 j-i71 jU4t c- MA) 56-6 Ox a. <br /> L/ City State Zip o ti <br /> Applicant's Telephone Number: <br /> ro <br /> Applicant's Email: OLsocD y,4400 <br /> I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. Y <br /> b � <br /> L <br /> ]Letter Phone []EmailN <br /> Legal Description: Lbt A Birt 454 S Vo(_ a 5 N e_ ao l Dcc_ y-2,(r 3 33 P-m-k- e, (6C AOQ <br /> , <br /> Lot#: ( CSM Vol. 459$ Pg. .201 OR <br /> Lot#: Block#: Subdivision Name: OR R „ <br /> Gov't Lot#: OR 1/4 1/4 W E <br /> Section#: /3 Town#:_yL_N Range W Town of: id3 Fi <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* y 1 <br /> r <br /> N <br /> Parcel#(24 digits): D 7- O - a - 4 l- I(o - (3- 5 15- 0'l5/-- o l 3/o v u <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: t G � <br /> Road Name: 'fa Wed. VZ&D City: �h1�bwRrf laL. <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rce.300 <br /> 'Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> LlSingle Family Addition Ll Multi-Family Addition 13Deck/Patio ❑ Commercial Addition <br /> Ei <br /> LlStairs LJAcc. Structure(Non-bunkhouse) LlBunkhouse ❑ Commercial Acc. Structure <br /> N <br /> LlPermit Extension ❑ Gazebo-WI Statnn59.692(ly) L3Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: t R t7Gw 4 C <br /> ,// // (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) tr r.l <br /> Building Contractor: 4�. A-sscLt' &,jdrtt4. `/oyl SSC. ?/J'- LIF7 &FtI7 Z Z tl u�u <br /> 1 <br /> Anticipated Start Date: �IrP+C4GJ�1"h '� Q <br /> 20 <br /> Page 1 of 4 a C <br /> Burnett County,WI Land Use Application-Rev 1/2016 Z <br /> CIn-DE Fv� GocLbay IR&51 <br /> m <br />