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LAND USE PERMIT APPLICATION —Burnett County, WI a _ <br /> Permit Fees: J� <br /> Dwell in /Prinei al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building S300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure 5150 Accessory Structure or Bunkhouse $250 <br /> Accessory Structure-Commercial CI&I1) $200 Addition to Accessory Structure-Commercial(C1&11) $200 <br /> Deck/Stairs/Patios $125 Gazebo W1 Stat 59.692 lv $350 <br /> 0 <br /> <, <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $loo <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 farm,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as. pergolas, landscaping,retaining waits. <br /> ro <br /> Applic4m'Cp npl9dAll Sections Below This Line r- <br /> z,C <br /> Applicant's Name: ck V % N < <br /> Applicant's Mailing Address: l 6yy-3e rr PI N 550$1 4► <br /> City State Zip ro <br /> 3 <br /> Applicant's Telephone Number: ! - 7 S/- L/3 11 <br /> Applicant's Email: of ck eA Z: u t•C-(or,C a rr+ c e <br /> O <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. vP 4� <br /> v ` I <br /> ❑Letter (Phone ❑Email 00 C }> <br /> Legal Description: 3493 C4-1 Rte! Lc.+ 2 (- 5l"% ilflroi 0 IP <br /> 0N O <br /> Lot#: CSM Vol. Pg. OR o J t <br /> Y <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 o <br /> F <br /> o t <br /> Section#: 7.6 Town#:--j o N Range#: ..L:5r W Town of: 7 <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed.* P t <br /> bl - 01 � - � -yO -K ' 1G - f <br /> Parcel#(24 digits): 5 y S- 0 0 i - p l 1 Oct-0 ae r G e ! <br /> f <br /> Tax ID#(1-5 digits): S rP al r z <br /> 3 4 9 <br /> Property Site Address#: 3 N <br /> _G <br /> Road Name: C-4--1 R o c rJ City: (Al e h <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: ,O <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> I&Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure(Non bunkhouse) LJ Bunkhouse LI Commercial Acc. Structure 11 <br /> N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition z <br /> n <br /> Proposed Structure/Addition Use: A 4 n-e h oc r a 5< <t <br /> (Ilom7 e/Cabin;Coereial Business;Bedroom;Deck;etc.) ,�'-�n' <br /> O� <br /> Building Contractor: y•oy G r �t C.• 4yt{�r 1L. LI!; qi< - 5F� <br /> _ MaWrr pc�ov- Z N _� <br /> p 111 aay �(�}CiS — E..ri G .'j i O <br /> Anticipated Start Date: Q <br /> S aPag O o <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2015 [�'� <br />