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LAND USE PERMIT APPLICATION— Burnett County, Al UP-15-'184 <br /> caner <br /> Permit Fees: <br /> $30 IN# <br /> Dwellin nci al Building-Single Family 0 Addition to Dwelling/Principal Building-Single Family $200 <br /> $30 <br /> Dwelling/Principal Buildin -Multi-Family 0 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> $30 <br /> CommercialAndustrial Building 0 Addition to Commercial/Industrial Building $200 1 3ermit Issued <br /> $15 Date) <br /> Accessory Structure/Addition to Acc.Structure 0 Bunkhouse 5250 Sanitary Permit <br /> $20 0. Issued <br /> Accessory Structure-Commercial C 1 &I1 0 Addition to Accessory Structure-Commercial C 1&11 $200 Date) <br /> $12 Town <br /> Deck/Stairs/Patios 5 Gazebo Stat 59.692 lv $350 <br /> $10 <br /> Camr)ing Unit 0 Filling/Grading 5150 /4 <br /> 10 <br /> Permit Extension Valid for one year-Only 1 Allowed $0 /.Gov't <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. °t <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. of CSM <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas, landscaping,retainingwalls. Vol. <br /> g S <br /> Applicant Complete All Sections Below This Line T N <br /> Applicant's Name: M.I&A_1 lAD�iT1_-I � ubdivision <br /> Applicant's Mailing Address:�050 'V,'�c IM Dle,'DC, Men'V" rtG M14 55 34P1 <br /> CitySt to Zip Zoning <br /> istrict <br /> Applicant's Telephone N (^ <br /> umber: ji 3 f)l - 2y - I I G3 Lake Class <br /> Applicant's Email: !MnnreAearic kS 2-7 (R-Q m 91.co rVl <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. FOR OFFICE <br /> ❑Letter ❑Phone 'L Email 5E <br /> Legal Description:�a3,ttInow Lx- lce U4 27 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1A 1/4 <br /> Section#: �(�Town#:7r4j} N Range#:-RA-6_W Town of. jailt4 <br /> *Attach addition/page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): d h - 020- 2- 4 0-1(o- I Po -5` ii 5- (0 51 - o34000 <br /> Tax ID#(1-5 digits): 140, 173 <br /> TH <br /> Property Site Address#: sl <br /> is <br /> Name: Vb+ D-C y 01 C1 1.,d City: :Dan r4 Do 1-kNI -10 <br /> N <br /> TYPE OF PERMIT(S): Check appropriate boxiboxes G C <br /> ❑ Single Family L3 Multi-Family Dwelling ❑ Fiiling/Grading L3 Commercial Building ST Me R U <br /> Dwelling m z <br /> Ll Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio Ll Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ <br /> Structure Acc. N u u u <br /> 1111 8 C=) <br /> Ll Permit Extension Ll Gazebo—VVI Stat 59.692(1v) 13 Camping Unit ❑ Commercial Acc.Addition ct:CrV <br /> E <br /> Page 1 of 4 ST <br /> Burnett County, WI Land Use Application-Rev 4/2015 M <br /> P <br /> BE <br /> RE <br />