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LAND USE PERMIT APPLICATION—Burnett County, WI & C <br /> a <br /> Permit Fees' 0' <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 1 a ` <br /> d <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin rinci al Building-Multi-Famil $200 V Q <br /> CommerciaVIndustrial Building $300 Addition to Commercial/Industrial Building $200 pT") <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 £ <br /> Accessory Structure-Commercial CI &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 a- <br /> Deck/Stairs/Patios $125 1 Gazebo WI Stat 59.692(l v)) 1 $350 0 <br /> Camping Unit $100 Fillin Gradin �- <br /> $150 <br /> Permit Extension Valid for one year-Only I 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, landsca in ,retaining walls. $ <br /> 'v <br /> ° <br /> Applicant Complete All Sections Below This Line <br /> Lo„PEW �42(-nG�( z <br /> Applicant's Name: �0,w.v.e� .� ° <br /> � " W <br /> Applicant's Mailing Address:_ 01lagS Q6x&Qt,a /�vQ ti>r (5 Cwjqyn,v 55330 <br /> City State zip <br /> Applicant's Telephone Number: 14 1- 34111 /Ip\2-'34 S-G1.0b r✓aAQ o y <br /> — c <br /> Applicant's Email: ,o , , , o <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> El Letter E3Phone mail c <br /> Legal Description: %- a S LSMy►o V' 24-7-5' 'VN., <br /> d <br /> Lot#: S CSM Vol. \O Pg. L -15' OR <br /> Lot#: Block#: Subdivision Name: OR u, <br /> Gov't Lot#: OR 1/4 1/4 } c <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.* 1 <br /> Parcel#(24 digits): 01 -b 3 to- L-40-%-1- Z3- 5 G 5-00 <br /> Z4 9�� �. <br /> z <br /> Tax ID#(1-5 digits): N � <br /> H <br /> Property Site Address#: 'oky 4 3 <br /> Road Name: Cw-rt)aer VC).v%\- City: l,Utz�lS�er <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:me_cv <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition Cl Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure o <br /> N <br /> ❑ ❑ iD � <br /> Permit Extension Gazebo-WI Stat 59.692(iv) Camping Unit El Acc.Addition C ` ../ <br /> ° 00 <br /> Proposed Structure/Addition Use: ((\, �� �j��j-�'� p�� (5 a N TZ c t a t1 <br /> ` ( Vm�e/Cabin;Commercial Business;Bedroom;Deck;etc.) 7 0 <br /> Building Contractor: r, Z o l' <br /> Anticipated Start Date: n <br /> Page 1 of 4 ma <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> 3 <br /> 7 <br /> n <br /> A <br /> n <br />