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LAND USE PERMIT APPLICATION — Burnett Count, NN'[ a <br /> Permit Fees: <br /> R tJt <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwellin Princi al Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 rN <br /> Commercial/Industrial Building $300 Addition to Commerciallindustrial Building $200 �( - <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &I1 $200 Addition to Accessory Structure-Commercial Cl &11) $200 Jj <br /> Deck/Stairs/Patios 1 $125 1 Gazebo WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/GradingSIM--, �' <br /> Permit Extension Valid for one year-Only 1 Allowed) 1 $100 , <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <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 /> Applicant Complete All Sections Below This Line �. <br /> Applicant's Name: JOKAl C. 1,41LJ4&= ° <br /> Applicant's Mailing Address: (OyS VALE Cr, Afol[4—H. ;55Jtae(1/ek1 141) :5'�'W <br /> p City State Zip b <br /> Applicant's Telephone Number: 7 r2 �3 V-0 a k&((%a-0\! o_ y # <br /> Applicant's Email: OQ <br /> JM $16T1/Y{n- ®CotKCg t N o <br /> d <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ZfPhone ❑Email N °` <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR o <br /> N 1 .1 <br /> Lot#: Block#: Subdivision Name: OR y t 1 <br /> Gov't Lot#: OR 1/4 1/4 F r I <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* y <br /> Pg .r f 8 Y P PY .r Y P P tYPg <br /> Parcel#(24 digits): G <br /> Tax ID#(1-5 digits): z <br /> Property Site Address#: c2gBf 3 <br /> Road Name: rLA$4 4 J4A�& Ae/I/6� City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recao�D <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> gSingle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 1 <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> n (1 <br /> Proposed Structure/Addition Use: <br /> GAb�AJ y <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: �4SK O L Ilio a0p7IZUC�,J K <br /> l 020 <br /> Anticipated Start Date: S . 1; <br /> m <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> a <br /> m <br />