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LAND USE PERMIT APPLICATION—Burnett County.WI r <br /> a � C <br /> w' F+ <br /> Permit Fees., a <br /> a <br /> DwellingtPrincipal Buil -Sin a Family 5168 Addition to Dwelling/Principal Builth -Sn"ft FamilyC7 �i <br /> DwelhnVPrincipal Buil -Multi-F5300 Addition to Dwellingftincipat Build' -Mulfi-Famfly 5166 m <br /> Commemaldndustrial Building 5300 Addmon to Budding 5200 O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse 5250 <br /> Accessory Structure-Conunercial Cl&11 UN Addition to Ac Structure-Commercial Cl&11 5200 � e <br /> Deck(StairstPatios $125 Gazebo Stat 59.692 1v 5350 c <br /> Camping Unit 5100 Fill $150 <br /> Permit Extension slid for one year-Only 1 Allowed) 5100 <br /> 0 <br /> 'NOTE:After-the-fact(when no permit is obtained prior to construction)is three tires the normal fee. v <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. <br /> *Items not listed above will be treated as accessary structures,such as:pergolos,landscaping,retaining walls. <br /> ro <br /> MApplicant Complete All Sections Below This Line c �. <br /> Applicant's Name: Dcz l / l a )z 13Qi t-Ao � <br /> i <br /> Applicant's Mailing Address: yY`/S Crrt'en haven �ry-^A cr 5 /lei 4�t`S (% 55110 <br /> v City State Zip a <br /> Applicant's Telephone Number: (o 5/ 3 9Q y 7 C <br /> Applicant's Email: o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 7 e <br /> ❑Letter CQPhone ❑Email <br /> Legal Description: ' <br /> Lot#: CSM Vol. Pg. OR Sy A c-FOet'; s I.n/f e q <br /> Lot#: '��Block#:_ Subdivision NameAlbeit K,Ae-c itf s OR � <br /> Gov't Lot#: OR 1/4 1/4 ��yy / <br /> Section#3 Town#: (�N Range#._j6 W Town of: VG K IQrtC! II JJ <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):0"7-0,1 <br /> `0ct <br /> Tax ID#(1-5 digits): 41%50 n z <br /> Property Site Address#: 7 8 y <br /> Road Name: !1 e 1 L Ad - City: �ICYiTC� <br /> TYPE Of PERMrr(S):Check appropriate box/boxes /� <br /> Fee Rec: We—m <br /> ❑Single Family Dwelling ❑ Mu16-Family Dwelling ❑Filling/Grading LJ Commercial Building <br /> X Single Family Addition ❑ Multi-Family Addition ❑DedyPatio ❑ Commercial Addition <br /> ❑Stairs ❑ Acc.Structure(Pon-bunkhouse) ❑Bunkhouse ❑Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> Proposed Structure/Addition,Use: O PC� y <br /> tw �--- <br /> (Nnme%Cahin;Commercial Busirress;Bedroom,-Deck etc) <br /> Building Contractor. 5Y/7r�Ys°/Z COL vt �l�i �rj�__�Qyj%�y e Z D <br /> Anticipated Start Date: 5-1b M <br /> t—r <br /> Page 1 of 4 0 ao ou <br /> Burnett County,WI Land Use Application—Rev 1/2016 O _R <br /> Z CX) <br />