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LAND USE PERMIT APPLICATION -Burnett County, WI G b <br /> a _ <br /> N N� <br /> Permit Fees: 0 to <br /> a <br /> DwellingfPrincipal Building-Sin le Family $30W Addition to DwellingTrincipal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $3#0 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciallIndustrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 7 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> 0 <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 andfees. 2 ( 1 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping, retaining walls. <br /> -o <br /> Applicant Complete All Sections Below This Line <br /> I o <br /> Applicant's Name: �t Uj d � (g►�Pe (/ L.) -r— -X- G on-1� <br /> Applicant's Mailing Address: 9,1716 <br /> /�6 Mirruo, R4 [-)"YLi U7 6qs-2— <br /> City State zip <br /> Applicant's Telephone Number: [�?� — -1© - 1�� C✓ [p�- _ 3ayCl o y <br /> {{ <br /> Applicant's Email: _ VW"! <br /> ie <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> ❑Letter Phone ❑Email N 0° ' <br /> Legal Description: lot .a CS iM V14 <br /> �i )q lxl l <br /> Lot#: CSM Vol. 42 g. 1 / OR d <br /> J <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR NtU) 1/4 _1/4 E <br /> Section#:�Town#:_► _N Range#:�W Town o£ 15 cu;SS <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* IVB"► y <br /> Parcel#(24 digits): <br /> JrW <br /> Tax ID#(1-5 digits): a? /'r/�/y <br /> ^ z <br /> Gw <br /> Property Site Address#: 1 7 to, w <br /> Road Name: Mt r1''r'U�.� RA. City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec-330QQ <br /> mingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension 13 Gazebo <br /> '-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> Proposed Structure/Addition Use: !7 Ci+s L 15 j Z D <br /> (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) ®� <br /> tQ� <br /> Building Contractor: tJ/ASCa/ �� g fru ter I N �u <br /> l _ iS - o 0 <br /> Anticipated Start Date:_ Z <br /> Page 1 4 <br /> Burnett County,WI Land Use Application—Rev 4/200 15 <br /> z <br /> M <br /> a <br /> m <br />