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E <br /> A <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Permit Fees: <br /> Z <br /> a <br /> llwellin /Princi al Building-Sin ]e Family t$300 Addition to llwellin rinci al Buildin -Sin le Famil $200 llwellin /Princi al Buildin -Multi-FamilAddition m Dwellin /Princi 1 Buildin -Mult-Faro"] $200Commercialllndushial Buildin Addition to CommercialMdustrial Buildm rAccess Structure/Addition to Acc.Structure Bunkhouse Access Structure-Commercial Cl&II Addition to Access Structure-Commercial Cl&II 1 <br /> DeckJSYairs/Patios $125 Gazebo Stat 59.692 Iv Cam in Unit $100 Fillip /Gradin r- <br /> 0 <br /> Permit Extension Valid for one year-Only 1 Allnwed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normil fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas, landscaping,retainin walls. q <br /> Applitatit Complete All Sections Below This Line <br /> z c� <br /> Applicant's Name: <br /> Applicant's Mailing Address: 8 Z N /YI 1't1 ST tea I t7.7'torrT e Ill. e <br /> City State Zip b <br /> Applicant's Telephone Number: 676-1 yOr3' 2_5_X-'1- <br /> F <br /> Applicant's Email: Kex/Gc b o%r 2_T�B V£ , C0.421 v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v F <br /> ❑Letter uphone ❑Email I <br /> � 1 <br /> Legal Description: <br /> 0 <br /> Lot#: CSM Vol. Pg. OR a <br /> Lot#: Block#: Subdivision Name: OR J <br /> y <br /> Gov't Lot#: OR 1/4 I/4 <br /> Section#:_0 * Town#:-3qN Range#:__/t4_W Town of: Q ) <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Parcel#(24 digits):_ ©.2 X 2 Dom— <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 2 66S <br /> Road Name: 4va .E Y.6F elliep ( City: Lc1 f�- r7r'�y W <br /> TYPE OF PERMIT(S):Check appropriate box/boxes y Fee Rec r Q' <br /> `Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Pabo ❑ Commercial Addition � <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> C <br /> a M <br /> Proposed Structure/Addition Use: Ale o { Z v <br /> m <br /> / (Ilome/Cabm;Commerc`ial/Business;Bedroom;Deck;ere.) W <br /> Building Contractor: 9jW_ lrT r T -4. . /y� , � <br /> O v <br /> O_ <br /> Anticipated Start Date: J /,gfl Z p u n <br /> Page 1 of 4 0 -4 r----� <br /> Burnett County,WI Land Use Application—Rev 1/2016 4 <br /> x <br /> Sf� JAS5t& 673 <br />