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LAND USE PERMIT APPLICATION-Burnett County, WI g <br /> y N <br /> Permit Fees: S to <br /> X Dwell' inc' Building-Single Family $300 Addition to Dwellin c' al Building-Single Family $200 <br /> d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 -A, �0; <br /> Commercial/Industrial Building 5300 Addition to Cominercial/Industrial Building $200 n b C <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 1 d <br /> Accessory Structure-Commercial(Cl&Il $200 Addition to Accessory Stricture-Commercial CI&II $200 0 <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692 lv $350 <br /> 0 <br /> c <br /> Camping Unit $100 Filling/Grading $150 .: <br /> Permit Extension Valid for one yeaz-Only I Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m , <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. / l <br /> ro V <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: S feee 'AUet_n C.)!r S eo <br /> Applicant's Mailing Address: y g�/ I/e2 Sure�S�icnG �rt✓e �prl�u/� Wi' S V e3o <br /> City State Zip ro <br /> z <br /> Applicant's Telephone Number: a6a -5a73a97 <br /> c <br /> J <br /> Applicant's Email: S t"eqpA fn I SC..y t-* <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ❑Letter U[Phone ❑Email N <br /> o � <br /> Legal Description: 5 _ <br /> Lot CSM Vol.. r Pg. 195 OR / 4d d, 6"on Tv ° _L <br /> Lot#: 76 Block#: Subdivision Name: lea-swe Is u Q OR Vayupf' <br /> Gov't Lot#: OR 1/41/4 //u �j 1 <br /> Section#:_/a Town N Range#:__Z5 W Town of: Jac Ws p <br /> *Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system property page- <br /> Parcel <br /> age.* a I <br /> Parcel#(24digits): 77--y/.2-a- yy-/5-IL -5 f5 -7.50 -egg3iOO r <br /> Tax ID#(1-5 digits): 870!Y � 7y <br /> w <br /> Property Site Address#: 2 9 0`16 <br /> Road Name:7,-aS 1-t r e )'5/a hd Tama i lltw✓'a� City: K q <br /> TYPE OF PERMIT(S)- Check appropriate box/boxes Fee Rec.—,OD <br /> )(Single Family Dwelling ❑ Mutti-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition E2 <br /> e <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure <br /> N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑Camping Unit ❑Commercial Acc. Addition <br /> Proposed Structure/Addition Use: Acme, n � o <br /> (Home/Cabin;Commercial Bunness,:Bedroom;Deck;e1c.) NZ C7 c <br /> Building Contractor: fL,a r'y S tre i2 k�e Z—4 1 �7 <br /> �p IJ u tl <br /> Anticipated Start Date: ©—/ /5 0 0 0 <br /> Page 1 of 4 d Z <br /> Burnett County,WI Land Use Application-Rev 4/2015 <br /> x <br /> M <br /> z <br /> m <br />