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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Permit Fees: <br /> a <br /> Dwellin=iPrinci al Building-Sin le Family $30 Addition to Dwellin Princi al Building-Sin le Famil $200 O _— <br /> Dwellin Princi al Building-Nlulti-Family $300 Addition to Dwclling,Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 � <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 t— 1 <br /> Accessory Structure-Commercial(Cl&Il $200 Addition to Accessory Structure-Commercial Cl&Il) $200 <br /> Deck/StairsiPatios $12.5 Gazebo WI Stat 59.692 lv $350 <br /> o <br /> Camping Unit $100 Filling/Grading $150 <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 requirea different application form, see corresponding application andfees. ° <br /> *Items not listed above will be treated as accessory structures,such as:pergolus, landscaping, retaining walls. 2 <br /> ~c <br /> / z <br /> Applicant's Name: J 69Gr.✓t � XIC(1mic.� �` <br /> Applicant's Mailing Address: Ts 5 C L✓.'S< J'c1 fm;4 ClWh mJ' �o�� <br /> City State Zip 3 b <br /> z <br /> Applicant's Telephone Number: c> <br /> Applicant's Email: $rIHCCnr.*sic fab <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. �� 5 <br /> ❑Letter EgKone [f nail N <br /> Legal Description: �ae t S.\/ ti/ 7130 ' of 1:�/VL /1/i,✓ S7tJ L &)r G �' <br /> Lot#: CSM Vol. Pg. OR p&SC oh t/ P Sbtt <br /> �. <br /> Lot#: Block#: Subdivision Name OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range it: W Town of: Ye*o'ztk <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro ert a e.* �/ <br /> / S J 1 P copy Y P P YPS <br /> Parcel#(24 digits): U-7 /el - ?o _ 3 0,,� — coo - e'1-70o o r <br /> Tax ID#(1-5 digits): 197-V4 <br /> Property Site Address#: 2 77?k <br /> Road Name: ANW'r�ymolor ��� City: 1'1'?1r4, !✓Z <br /> TYPE OF PERM T(S): Check appropriate box/boxes Fee Rec3u-)!,Cj <br /> Qi-tingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Sngle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Ace. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Ace. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(l v) ❑ Camping Unlit ❑ Commercial Ace. Addition 1 <br /> Proposed Structure/Addition Use: U/1�, do=.Fe' — Coi�dc5/r:r �v l'C<�/n (Sin °0� ''/�>/ �'J <br /> (Hoe/Cabin;Commercial Business;Bedroom:Deck;etc.) M <br /> m <br /> Building Contractor: 40 <br /> 1 <br /> (cYS/c:-1 <br /> t� <br /> N <br /> Anticipated Start Date: 4�r1f�/L <br /> Pagel of 4 <br /> Burnett County, WI Land Use Application–Rev 1/2016 n—] <br />