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W -0 r <br /> / LAND USE PERMIT APPLICATION-Burnett County, WI gi. c <br /> < "d <br /> Permit Fees: <br /> Dwellin ncipal Building-Single Family $300 Addition to Dwellin ci al Building-Single Family 200 <br /> Dwelling/Principal Build' -Multi-Family S300 Addition to DwellingRrincipal Building-Multi-Famil $200 <br /> Commercial/industrial Building 5300 Addition to Commercial/industrial Building S200 <br /> Accessory Structure/Addition to Ace.Structure 5150 Bunkhouse 6250 <br /> Access Structure-Commercial &II $200 Addition to Accessory Structure-Commercial(CI&11 5200 <br /> Deck/Stairs/Patios 5125Gazcbo WIStat59.69211v)) 5350 a 1 —> <br /> Camping Unit $100 Fillin Gradin $150 S <br /> Permit Extension Valid for one year-Onl 1 Allowed SI00 <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(ees. <br /> *Items not listed above will be treated as accessory structures,such as: r olas,landscaping,retaining walls. <br /> e <br /> Applicant Complete All Sections Below This Line S <br /> z <br /> Applicant's Name: n1�1-J� urit�fssut ��At6.L J <br /> Applicant's Mailing Address:_ _��ff SaL r Y1Uttto[ - i two Syyn <br /> City State "Lip <br /> Applicant's Telephone Number. <br /> 16>. SILc,DG�l�I o y <br /> Applicant's Email: h:rvnoA�c' � !AW <br /> n <br /> If staff has a question about this application how do you prefer to he contacted? Check one below. I <br /> ti <br /> ❑Letter / [�Kyd� email Sts i(C* F'cecrae4ru4a�.cn ; <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR 5 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#; / ORSIE_I/4SE1/4 1— {� <br /> p YI <br /> Section#: [0 Town#: �/0_ N Range#: W Town of: <br /> *Attach additional i needed or lent description OR attach a co o the deed OR attach tux stem property e. <br /> Page f f lengthy P PY I s7' P oPe tY Pag I <br /> Parcel#(24 digits): - Cid g -9 -tIo-l y-I D ' S Com-CSO l - 0- P O D CI <br /> f q " z <br /> Tax ID#(1-5 digits): l f-7 c�J 7 1 <br /> 12 <br /> Property Site Address 11to _ T�,� e16 - <br /> /� 0 <br /> Road Name: suLoe Qe&e1K _- City:a <br /> TYPE OF PERMIT(S):Chedc appropriate box/boxes T Fee Rec: �). <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building - <br /> i7 <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commerdal Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat S9.692(1v) ❑Camping Unit ❑Commercial Acc.Addition <br /> n <br /> Proposed Structure/Addition Use: ft _ > C �1 <br /> �� (Hum¢/Cabin:Commercwt Business;Bedroom;Deck:eta/ Z m <br /> Building Contractor. /!ce, LG&10-- N n <br /> z <br /> Anticipated Start Date: /O/ ,/ — Z 0 <br /> Page 1 of 4 tib o <br /> Z <br /> Burnett County,WI Land Use Application-Rev 4/2015 > <br />