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LAND USE PERMIT APPLICATION—Burnett County,Al <br /> Permit Fees: <br /> Dweilin ci al Building-Single Family $300 Addition to Dwelling/principal Building-Single Family $200 a <br /> Dwelliiici al Building_-Multi-Family $300 Addition to DWellingftmcipal Building-WIti-Faro' $200 m <br /> Commercial/Industrial Building $300 Addition to Commercial/tndustrial Buil $200 1 � p <br /> Accessory strtio wAddition to Acc.Structure $iso Bunkhouse $250 1 <br /> Accessory Structure-Commercial C 1&Il $200 Addition to Accessory Structure-Commercial C] &11) $200 <br /> jj <br /> $125 Gazebo WI Stat 59.692(]v) � �' <br /> Deck/Stairs/Patios °1. ( <br /> Cam in Unit $100 Filling/Grad]a $150 r <br /> Permit Extension Valid for one year-0111Y I Allowed $100 <br /> *MOTE:After-the-fact(when no penuit is obtained prior to construction)is three times the normal fee.' <br /> fBrent application form,see corresponding application on andfees.*Communication Towers&Signs re4 wre a d . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,Imubca in ,retaining walls. „e <br /> m <br /> Appy- letC't o Z <br /> o <br /> Applicant's Name: 'eR4 Q. CX, DtJ <br /> ApplicatifsMailingAddress: J0/6 150A 59-: N • %5 t6JfW4'e� di2N cS�O{�a <br /> II <br /> p City State Zip <br /> Applicant's Telephone Number. 6107" Iola a IT Y <br /> Applicant's Email: QLSa,0 608 aD VO4.400 Cto/11 2 J <br /> io <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> OLetter OPhone [:]Etnail N t <br /> Legal Description: <br /> Lot#:�_CSM V01. tl f 9S Pg. 0101 OR 5_ <br /> Lot#, Block#: Subdivision Name: OR CA <br /> o <br /> Gov't Lot#: OR 114 1/4 <br /> c t � <br /> Section#: /3 Town#: N Range#: _W Town of: .SC_J/cS�P <br /> H � I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): D 1- a - a - tf!- a f�- t 3- 5 ►5-- o YY- r 3 oa l�° <br /> ( digits): ' �dvra2 7�Wf� 2� 6� 4 z <br /> TeX ID# 1-5 dt its : �: w �t <br /> Property Site Address#: <br /> Road Name: JbWe4, UAD City: i7.�w1�w¢ L.�C• l <br /> TYPE OF PER14IT(5): Check appropriate box/boxes Fee Rec: S n G <br /> 'Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> 13 Single Family Addition ❑ Multi-Family Addition —eck/Patao ❑ Commercial Addition <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazeta–WI Stat 59.692(Sv) ❑Camping Unit ❑Commercial Acc.Addition f� <br /> Proposed Structure/Addition Use: <br /> n <br /> {Ifane abin;Commercial Business;Bedroom;Deck;etc.) 'Z C <br /> Building Contractor: 4t:�-r1A-SJC t' S1R.wR.b//Oy .7W& 71Jr"WZ r 67YVI6,9.tv 10 <br /> O <br /> Anticipated Start Date:_ t - / No <br /> ((( Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 1/2016 Q <br />