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P <br /> En <br /> LAND USE PERMIT APPLICATION- Burnett County <br /> W1 <br /> Permit Fees: 0 <br /> Ir Y, <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Sin $200 30 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling(Principal Building-Multi-Farnily $200 <br /> in le Fammil $'00 <br /> u'u_Farru, "00 <br /> $200 <br /> i 1 C I all $250 <br /> Wal C I &I=I <br /> Cornmerciallindustrial Building $300 Addition to CommerciaUIndustrial Building $200 7_15 <br /> Ac --IVAddition to Acc.Structure <br /> cessory Structur <br /> Bunkhouse $250 <br /> AccesAu Commercial(C I &It) $200 Addition to Accessory Structure-Commerc $200 <br /> _g"S"ture- <br /> 12 <br /> Deck/Stairs/Pafios Q $ 51 Gazebo(Wl Star 59.692(tv)) $350 <br /> ing Unit <br /> 1 $100 Filling/Grading $150 :> <br /> Perrnit Extension(Valid for one year-Only I Allowed) 1 $100 <br /> *NOTE:After-the-fact(when no pennit is obtained prior to construction)is three times the normal fee. CA <br /> *Communication Towers&Signs require a different applicalionform,see corresponding application andjees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> Z <br /> Applicant's Name: 14.0 e4,4 S J?414rc 4r1k <br /> Applicant's Mailing Address: Z 3 9-3 Alk-fipelpmeil AtIc.- HAipe-reja6a Mki <br /> City State Zip <br /> Applicant's Telephone Number: (>S-(— 1'7 0—76 74 <br /> A, <br /> Al <br /> A <br /> Applicant's Email: _T_�T_R iE"G RW_t cc,:�M M M <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> CLetter ElPhone E]Email <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: 13, Block#: Subdivision Name: <br /> Gov't Lot#: OR-1/4 1/4 <br /> Section#: Town#: <br /> ON Range#::j7? W Town of- U V1 1149 J01 <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> [Property Site Address <br /> Road Name:—j3U4 t, A t-kpV LAAJK: CitN: A AJ J3 cttR Y <br /> TYPE OF PERMrT(S): Check appropriate box/boxes Fee Rec: <br /> U Single Family Dwelling Q Multi-Family Dwelling 0 Filling/Grading Ll Commercial Building <br /> El Single Family Addition E3 Multi-Family Addition *Deck/Patio C3 Commercial Addition <br /> IZI Stairs �W Acc. Structure(Non-bunkhouse) U Bunkhouse El Commercial Acc. Structure <br /> 8 CD <br /> 0 Permit Extension 13 Gazebo—WI Stat 59.692(lv) El Camping Unit E3 Commercial Acc. Addition Z a <br /> Proposed Structure/Addition Use: GOCA 04Cc <br /> (HomelCabin:Commercial B�lness:Bedroom;Deck;etc.) ff J­tj <br /> WAD <br /> Building Contractor: r� =._ <br /> Z C� A <br /> Anticipated Start Date: 0 <? /ad/4- <br /> Page I of 4 <br /> Burnett County, W1 Land Use Apptication—Rev 4/2015 <br />