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LAND USE PERMIT APPLICATION —Burnett County, WI a _ 1 <br /> Permit Fees: ; to <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin rinci al Building-Sin le Family $200 � C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellinglPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 - <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1 &11) $200 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat59.692(lv)) $350 c l <br /> Camping Unit $100 Fillin Gradin <br /> $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 0 <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. 2. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> b <br /> l Applicant Complete All Sections Below This Line 0 <br /> pp <br /> A licant's Name: <br /> Applicant's Mailing Address: z y9y3 �� 3S <br /> City State Zip <br /> � — S� 49 —Applicant's Telephone Number: ono — z <br /> y # <br /> c C <br /> Applicant's Email: Gtl $tom ems, , A G <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> Letter ❑Phone ❑Email N °� <br /> Legal Description: 'g UJ <br /> w <br /> Lot#: CSM Vol. Pg. lOR' 4 f� d <br /> Lot#: Block#: Subdivision Name:W tt VICJ I ��� / ft S OR „ <br /> Gov't Lot#: OR 1/4 1/4 r o <br /> Section#: Town#: N Range#: W Town of: 70,e 4 ° t <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax systemproperty page. y <br /> I <br /> Parcel#(24 digits): 0 <br /> Tax ID#(1-5 digits): z <br /> y z <br /> Property Site Address#: 2'1162— y SO <br /> t W <br /> Road Name:_ k4414 -114 ..s e- City: St p Lcy�_ <br /> 01 9 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes F R <br /> L3 Single Family Dwelling Ll Multi-Family Dwelling L3Filling/Grading Ll Commercial <br /> ec:Commercial Building �tr_4 , \ <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ElPermit Extension LlGazebo—WI Stat 59.692(iv) C3Camping Unit ElCommercial Acc. Addition z <br /> i U�r <br /> Proposed Structure/Addition Use: L. h o a,y.,. ✓nu a AOS\ ���✓ oo� a N <br /> (Home/Cabi�nmercia[Business;Bedroom;De ;etc m <br /> z <br /> Building Contractor: K � <br /> Anticipated Start Date: CO N^t.n /r 60J n <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br />