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72 <br /> LAND USE PERMIT APPLICATION-Burnett County, WIb <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes)' g-` - <br /> p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c.,e <br /> J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 _Q n <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1J _ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 U U, <br /> Filling/Grading $150 Boathouse $500 t1 <br /> Six Month Camping Unit(One Per Year o `v <br /> p� g ) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> E <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to 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,etc. b <br /> Property Owner's Name: 5 P csj (-ABLE / 2.os ° - <br /> G AEH6RA/ GAl1s �l , Co 6/0261 <br /> .-m'6- <br /> 0 Properly Owner's Mailing Address:601e �n Ib <br /> 2.0-794-1- ��1�11.� fI ) l <br /> City l/1/ Sl���t� 1 <br /> PropertySite Address: n �1 <br /> q .S2 —V/i— �23� < <br /> Contact's Telephone Number: � o y Y± <br /> rt <br /> A) ( yA 1.00 . Cowl <br /> Contact's Email: T <br /> � <br /> Legal Description of Property: GZ GnDT SM V S /- 1 7 (IA (�Q j/ GM'S) <br /> Section#: 3 5 Town#: 2, 8 N Range#: / ' W Town of:�F(�(L5Tre o ° <br /> 3' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page * <br /> 0. <br /> Tax ID#(1-5 digit number;found on tax <br /> ��statement): 1 0 / S 3 <br /> Proposed Use of Structure/Additjon: (.t/,9 L/< 1419 V ,� <br /> Anticipated Start Date: /v ,220,2_ r (Hoose/Cabin;Commercial Business; c w Bedroom;Deck;etc.) � <br /> Building Contractor:Mkk Alm( bAt4 AT1DN Sewer Installer: A///l <br /> 5 <br /> - E <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDIT1ONS ONLY <br /> THIS PERMIT IS SUBJECT TO All CONDITIONS LISTED BELOW: p <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured 2 <br /> home additio s,and bunkhouses.** 7. <br /> g, il1ee/4-- c ( 5 <br /> E. Nom- Iv eKCee4 - v,'d <br /> el Oil? ?lace" :i. Vest q �e05 Carc�o�/ m <br /> Fee Rec: ��� <br /> / <br /> Initials of e vistaff:j K Check#: //4C1 <br /> Date of staff site visit: loh2.11?-1 <br /> �� t rnI <br /> APPROVED BY LAND SERVICES OFFICIAL: 0: 4 1 ATE: 10/??/ / < o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF _ g_ <br /> 1 ono. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 7' Uiiiil <br /> E. <br /> Transcendent: - Page 1 of 4 Q <br /> Laserfische: - <br /> Burnett County, WI Land Use Application—Rev fill <br />