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LAND USE PERMIT APPLICATION-Burnett County, WI 5r <br /> F R V <br /> G B <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin Princi al Building-Single Fami /$200 d �j <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil ' IWQOO <br /> Commercial/industrial Building Addition to CommercialAndustrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure Y $150 Bunkhouse <br /> Accessory Structure-Commercial CI&it Addition to Accessory Structure-Commercial Cl&Il $200 SZJ <br /> Deck/Stairs/Patios 1 $125 1 Gazebo WI Stat 59.692 Iv $350 c t <br /> e <br /> Camping Unit $100 Filling/Grading Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v n <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 /> b <br /> Applicant Complete All Sections Below This Line o �. <br /> Applicant's Name: -sa- KAfe,%_h �_^ <br /> Applicant's Mailing Address: to y` syr. � 5eu �t// <br /> e, rky. /13 <br /> City State Zip <br /> Applicant's Telephone Number: 4/rs7-0-67 o <br /> Applicant's Email: (Je t-I0,k� <br /> If staff has a question about this application how do you prefer to he contacted? Check one below. <br /> b � <br /> ❑Letter gPhone []Email o <br /> Legal Description: caw• (,o4- j_ -1. CZ 4Q T YOU <br /> Lot#: I CSM vol. pg. 9 3. OR C <br /> Lot#: _ _Block#: '—Subdivision Name: OR h� � <br /> Gov't Lot#: OR 1/4 1/4 pts l ti <br /> Section#: oLo`Z Town#: t4O N Range#:_(!W Town of: ' <br /> *Attach additional page if needed for lengthy descriptionORattach a copy of the deed OR attach tax system propertypage.* a I <br /> Parcel#(24 digits): 07- _)-71�' <br /> Tax ID#(1-5 digits): J__4�10 ❑ z <br /> In z <br /> Property Site Address <br /> Road Name: UYl1cL r t 1 City: (� <br /> F <br /> TYPE OF PERMrT(S): Check appropriate box/boxes Fee Rec: UD <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑Filling/Grading ❑Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑Commercial Acc. Structure <br /> LJ Permit Extension LJ Gazebo-WI Stat 59.692(iv) Ll Camping Unit Ll Commercial Acc.Addition Z <br /> /� / nr/'� <br /> Proposed Structure/Addition Use: (�{tg :, t�f!('!'<l�,tsKt!ryL 5PAC-C 46MAGQNo , C <br /> (Home/Cabi;Commercial Baseness;Bedroom;Deck,etc.) � <br /> / _ 4 2 <br /> Building Contractor: of N C <br /> 0_9 <br /> Anticipated Start Date: �j 1 //�(� Z n <br /> r-� <br /> Page 1 of 4 17 O Q <br /> Burnett County,WI Land Use Application—Rev 4/2015 a Z <br /> E� <br />