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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Permit Fees: o' <br /> 7 U <br /> a <br /> Dwellin rind Building-Sin le Family $300 Addition to Dwelling/Principal Budding-Sin le Family � <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family M$2CommerciaVlndustrial Buildin $300 Addition toCommerciat/Indusnial Buildin Accesso Structure/Addition m Ace.Structure $150 Bunkhouse <br /> m <br /> Accessory Structure-Commercial(CI&I l) $200 Addition to Accessory Structure-Commercial(C I&I l) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo(WI Stat 59.692(ly) $350 R- <br /> Camping Unit $100 F01' Gradin $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 O <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 retainin walls. .z <br /> m <br /> Applicant Complete All Sections Below This Line 3. <br /> Applicant's Name: �r2 9 --r- �Q r 0 � Na5 ce r elo <br /> Applicant's Mailing Address: CC&2y91/ =;ES2 � rs0/O <br /> City State Zip 9 <br /> Z <br /> Applicant's Telephone Number: 7tS 3 y� 9/la o y <br /> r: <br /> Applicant's Email: <-2n n rn d <br /> m <br /> ie <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone Email 00ro <br /> 0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR �? <br /> 3. <br /> Lot#: Block M Subdivision Name: OR na, <br /> Gov't Lot#: OR 1/4 1/4 o30 <br /> I <br /> Section#: _Town#:�iZN Range#:_Z,(,_W Town of: <br /> 'Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): 07—O lQ - /.4-/ 8-5 /5-5c7 o -O/e,Ono � <br /> n <br /> Tax ID#(1-5 digits): /5lQ-� n z <br /> � a7 <br /> N <br /> Property site Address M W ye//o w 4�D, LOT (o <br /> Road Name: Y�//O w /Qt lie r OGz cZ_ City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes .,,00,Co <br /> Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building x <br /> Single Family Addition ❑ Mufti-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> E3 <br /> ❑ Stairs 13 Acc. Structure(Non-bunkhouse) Ll Bunkhouse LJ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition z C <br /> Proposed Structure/Addition Use: /0 _ , _ a Z n <br /> c <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) 0 0 M <br /> Building Contractor: Z cfl <br /> . 0 <br /> Zo I <br /> Anticipated Start Date: C <br /> Page 1 of 4 o Z <br /> Burnett County, WI Land Use Application —Rev 4/2015 �� <br />