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rA <br /> LAND USE PERMIT APPLICATION - Burnett County, WI g <br /> y <br /> Permit Fees: °_ Q` <br /> a ! � <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 a <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 ( a <br /> Accessory Structure-Commercial(C I &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/StairsPatios 1 $125 1 Gazebo(WI Stat 59.692(l v)) $350 C) <br /> Camping Unit $100 Filling/Grading $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. <br /> ^o <br /> r <br /> o <br /> z <br /> Applicant's Name: T°ra'J R • ;4A R'T o <br /> Applicant's Mailing Address: "o ks-_s4o G: t'`a .yo®Dg�2�/ r1+t 5S a< <br /> City / State Zip b <br /> z <br /> Applicant's Telephone Number: (017--Z80, 7254 04- Si 82t o <br /> v <br /> c <br /> r <br /> Applicant's Email: lehn .�ar{ an v�er5enc.nrP . c-a .�� v <br /> a <br /> a � <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ao <br /> ❑Letter [Rfhone ❑Email N <br /> Legal Description: R"«R <br /> Lot#: -Z4 CSM Vol. Pg. OR <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 ` 1 <br /> Section#: Town#: N Range it: W Town of: 1 <br /> *Attach additional age ifneededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): L' '0 ZQ ' Z-`t O 1 le - o-/ -5 1!�-4 4 O - 0 33 0 00 <br /> Tax ID#(1-5 digits): t r )3-7 1 <br /> � � W <br /> Property Site Address#: 7-10 2 14 <br /> Road Name: V/• �/G L t"c w R r.l t R R b, City: Dd+-I 13 a Z��/ <br /> Cf <br /> E <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> 0 Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 0 Acc. Structure(Non-bunkhouse) WrBunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑Camping Unit ❑ Commercial Acc. Addition <br /> Proposed Structure/Addition Use: (,-A R A U L /13 j.i►` C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z '-; <br /> D <br /> Building Contractor: Z <br /> tv <br /> Rr,.iL <br /> Anticipated Start Date: 7-4c-. 1(G�� 17 0 0 <br /> Page 1 of 4 C Q, <br /> Burnett County, WI Land Use Application—Rev 1/2016 <br />