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Ln <br /> LAND USE PERMIT APPLICATION-Burnett County, WI g <br /> y � , <br /> y ~ <br /> Permit Fees: t;' <br /> a <br /> Dwelling/Principal Building-Singjc Family $300 Addition to Dwellin Princi al Building-Single Famil $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil rn <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> 1 O <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse $250 E <br /> 0 <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory Structure-Commercial(C1&11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 c G� <br /> Camping Unit $100 Filling/Grading $150 - <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 ree. Elt <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 /> -o <br /> Applicant Complete All Sections Below This Line o . <br /> ~ o <br /> Applicant's Name: .TIHg PqE <br /> Applicant's Mailing Address: 7/ /C� 141DOOJyffcL6--i 4,J5 0577066 6AW4 t*J <br /> City State Zip <br /> Applicant's Telephone Number: -011 C.tZ.e- &12-9 8/0-8 St80 0 <br /> Applicant's Email: -SIH. SclFOEIJ(3E726�2 @ Sk y CcNS71QtJCTloN. C oM d G <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. S <br /> Letter ®Phone Email <br /> 2 <br /> Legal Description: �' W <br /> Lot#:_ CSM Vol._ Pg. 7 OR r" <br /> ti s <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR C^ <br /> Gov't Lot#: OR 1/4 1/4j� � s <br /> Section#: Town#: 313 N Range#: IS W Town of: ,_g )::a ZL Z,` T I— (,v <br /> -� t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 9 <br /> CII V\ <br /> Parcel#(24 digits): 67- 01 - - 38 'IS-Oy -6-qS— QOz � op 1000 r, <br /> Z r <br /> Tax ID#(1-5 digits): 92PA ❑ <br /> Property Site Address#: 76�2 <br /> Road Name: .57-r)-rt- oA� 70 City: .s/rQt sl Wr Sy872 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 1-3 Fee R c. <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building 3 S <br /> ■Single Family Addition ❑ Multi-Family Addition ! Deck/Patio ❑ Commercial Addition K 513 <br /> u <br /> ❑ Stairs 0 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> 'L <br /> Z <br /> Proposed Structure/Addition Use: L/gk,C /7^67YFF ,ILti' k,41 �BRes�0V7- CD <br /> C <br /> (Home/Cabin:Commercial Business;Bedroom;Deck;etc. ^i <br /> / '- Z Z <br /> Building Contractor: 1}o/yE ocuJNC� < ® �^^ <br /> UUU <br /> Anticipated Start Date: mA L/' Z n N <br /> Page 1 of 4 G) O o <br /> Burnett County,WI Land Use Application-Rev 3/2015 > <br />