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LAND USE PERMIT APPLICATION-Burnett County, WI g (� b <br /> Permit Fees: Ir <br /> Dwellin Princi al Building-Single Family $300 Addition to-Dwelling/Principal Building-Single Family $200 i\ a <br /> 4' <br /> d <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Farm] $100 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 (. <br /> CA-ccessory Structure/Addition to Acc.Structureunkhouse $250 I Y t E <br /> Accessory Structure-Commercial(CIA Il $200 Addition to Accessory Structure-Commercial Cl &Il $200 1 `� <br /> Deck/Stairs/Patios $IL5j Gazebo WI Stat 59.692(l v)) -Z) <br /> 1 $350 c 1C. <br /> Camping Unit $100 Fillin Gradin $150 1' <br /> Permit Extension Valid for one ear-Only1 Allowed $100 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 /> Applicant Complete All Sections Below This Line o <br /> Z 9Q <br /> Applicant's Name: I/e Y f`C C)U'n P.Y G11 <br /> --`` V <br /> Applicant's Mailing Address: ��DLes Helcene QCT 00 bS-�e.r VU Li 9q <br /> City State Zip <br /> Applicant's Telephone Number: -7 )S- 19:�-O S-7S o_ <br /> PP <br /> A licant s Email�l�&.rC(;r 9LJ a C'jY11 11 <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter phone ❑Email N °� 1 <br /> Legal Description: 5 <br /> w <br /> Lot#: CSM Vol. Pg. OR o <br /> N 1 <br /> A <br /> Lot#: Block#: Subdivision Name: OR <br /> 1 <br /> Gov't Lot#: OR 1/4 1/4 F <br /> 0 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> *Attach additional page if neededror lengthy description OR attach a co fthe dee9R attach tax system property page. <br /> Parcel#(24 digits). 0 10 1(C- 3q l U�A -900 <br /> - CI I;L QQO � <br /> Tax ID#(1-5 digits): 10595 n z <br /> Property Site Address#: <br /> Road Name: He�er)e LQA City: t,ti)e yys,+c r <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�J�s� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition W <br /> n C <br /> H <br /> Proposed Structure/Addition Use: y A ^ <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) 0 ly G <br /> o `7 G <br /> 9 f <br /> Building Contractor: M YL l i nsir kp i j z e~o 1V <br /> Z n <br /> �'Cj._ 0 <br /> Anticipated Start Dater � — S G7 0m Z o, <br /> Page 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 > <br /> r <br /> x <br /> m <br />