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LAND USE PERMIT APPLICATION—Burnett County, WI ro r <br /> G <br /> a <br /> b <br /> rn � <br /> Permit Fees- <br /> a <br /> Dwellin Princ al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 t7 (R <br /> DwellingtPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommereiaVlndustrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial(CI&II) $200 <br /> Deck/Stairs/Patios 1 $125 Gazebo WI Stat 59.692(l v $350 <br /> Camping Unit $100 Fillip Gradin $150 <br /> Permit Extension olid 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. <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 /> ro <br /> Applicant Complete All Sections Below This Line S <br /> Applicant's Name: O !t1/15- to /- <br /> O ) <br /> Applicant's Mailing Address: a2 Q /� C K t3 tJ N �/por?�,/=4 1✓ f'y 80/ <br /> City State Zip o <br /> Applicant's Telephone Number: <br /> � 1:0 7/® - a7as' o N <br /> Applicant's Email: F}�t/N i O/m /4 42 /r1 S'd. L' o M d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> roSO <br /> ❑Letter Phone []Email N °° <br /> 0 <br /> Legal Description: N TT-/1 C (-I G l <br /> Lot#: CSM Vol. Pg. OR d . <br /> Lot#: Block#: Subdivision Name: OR 0i <br /> Gov't Lot#: 7 OR 1/4 I/4 � o <br /> Section#: .3 6 Town#: YG N Range#: W Town of: SG rJ "T i <br /> *Attach additionalPa8e ifneededfor lengthy description OR attach a copy ofthe deed OR attach tax system property Page. <br /> , <br /> Parcel#(24 digits): 0 -1 U A S- l -g 0 - I of - 3 6 s O s- 010 7 - D t 4J 0 O r <br /> Tax ID#(1-5 digits): <br /> y � <br /> Property Site Address#: 3 _ <br /> Road Name: t344eityAAr Rnq,) City: S/0O0ti0'a-IL <br /> (,f*e P i/ 7 o tY N YO-11/4 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 00 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Mind-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> +++������ °m <br /> L3 Stairs �Acc.Structure(Non-bunkhouse) Ll Bunkhouse 13 Commercial Acc.Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ouu <br /> Proposed Structure/Addition Use: t`n R I jI 4%/' s 1/l Z Ae f H/0'eQ Z D <br /> (Home/Cabin;Commercial Business; edroom;Deck;etc.) <br /> Building Contractor: Al L 2 i N 4 AN17 Q tJ (L l) 1/1,F 5 1/V e, ER <br /> u u Y <br /> Anticipated Start Date: [1 4 j D /.S' C <br /> E <br /> Page 1 of 4 d [� <br /> Burnett County,WI Land Use Application—Rev 4/2015 Lam/ <br /> z <br /> m <br />