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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> y <br /> Permit Fees: a os <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Build -Multi-Family $2011 V <br /> CommercialAndustrW Building $300 Addition to Commercial/industrial Budding $200 f, <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 W <br /> P <br /> Accessory Structure-Commercial(Cl&I1) $200 Addition to Accessory Structure-Commercial Cl&Il) $200 p <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(1 v)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> l (__ <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 /> a <br /> plic a Goll le `All its Btlow.Tw Line <br /> A� <br /> ! Z <br /> Applicant's Name: AV -d. bfAA A G <br /> Applicant's Mailing Address: Z(f`1 b M I T� C , Mjk E t WOOD, �}I SS I I <br /> r City State Zip <br /> Applicant's Telephone Number: Vr I ' 3 ' N� bsi ,G92.07q CC o " <br /> h � <br /> n — c <br /> , <br /> Applicant's Email: <br /> m <br /> a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ti <br /> � Letter Phone Email 0 1 <br /> Legal Description: 'D m' <br /> 4— <br /> Lot#: CSM Vol. Pg. OR <br /> a <br /> Lot#: Block#: Subdivision Name: OR a <br /> Gov't Lot#: 3 OR 1/4 I/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* y I <br /> Parcel#(24 digits): 01-0-32— 'Z'41 -I to- 33 s 0� -00-3- 015000 r, <br /> Tax ID#(1-5 digits): IJ <br /> Property Site Address#: 77 4�1 _ <br /> Road Name: `OOCLn D 1-At<4FIR i Jc City: 5 w i SS <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Ree-t <br /> k Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition s---1 <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> �� <br /> Proposed Structure/Addition Use: atN� �CoLf✓� l✓ z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: -­ 'oujn a, l 1ei f tLol(S f r(_ ie � p <br /> 0 <br /> Anticipated Start Date: I pp %t_ Z-Dl(. C: <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 1/2016 <br />