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LAND USE PERMIT APPLICATION— Burnett County, WI b <br /> Permit Fees: ; t! <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory StructurelAddition to Ace.Structure $150 Bunkhouse $250 1 <br /> h <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial CI &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(Wl Stat 59.692(Iv)) $350 ( —,I <br /> Camping Unit $100 Fillip Gradin $150 <br /> Pennit Extension Valid for one year-Only l Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ' /n <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas,landscaping,retainingVu walls. 1 <br /> Applicant Complete All Sections Below This Line o <br /> z <br /> Applicant's Name: J e P Y )/ p /�11-s <br /> Applicant's Mailing Address: 2 Cr aGt Pr?3Cd r — <br /> City State zip b <br /> Applicant's Telephone Number: o H C> <br /> a <br /> Applicant's Email: ^p <br /> d <br /> a — <br /> If staff has a question about this appXetter <br /> ion how do y u prefer to be contacted? Check one below. <br /> •o <br /> Fj Phone ❑Email NLU <br /> ��� ,, 0 <br /> Legal Description: VJL�� � / Z 00 <br /> OQ <br /> Lot#:JCSM Vol. /7 Pg. OR <br /> Lot#: Block#: [ Subdivision Name: J ! 5 M / OR 5 <br /> Gov't Lot#: OR 1/4 1/4 o <br /> Section#: Town#: N Range#: W Town of: LA 1,/ i-777�9 I a I <br /> *Attach additiona/page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> ® alb-2 - 3�-1�'�a'7 - 5 as �a0 .�o/zoaa <br /> Parcel#(24 digits): 7- <br /> ✓� � _ <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 5G 2�2 <br /> Road Name: 0//4 6 A P0N �w City: G ! 4. <br /> TYPE OF PERMIT(S): Check appropriate box/boxes /Fee/F/F i- mew, <br /> Ll Single Family Dwelling Ll Multi-Family Dwelling LlFilling/Grading Ll Commercial BuildingW(Ds ,1_le �� <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C <br /> d n <br /> Proposed Structure/Addition Use: F D Z m <br /> (Home/Cabin:Comme ial Business;Bedroo ,Deck;etc.) <br /> r t 1 U J <br /> Building Contractor: <br /> Anticipated Start Date: 9 r'(/l C <br /> Pagel of 4 c Z <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> S <br /> m <br /> A <br /> m <br />