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<br /> . LAND USE PERMIT APPLICATION - Burnett ('ounty, NVI
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<br /> Apylicant Complete All Sections Belot This Line
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<br /> Permit Types and Feeseleost,check oppropriate boxes)
<br /> Dwelling/Principal Structure $301) !Addition/Alteration to Dwelling/Prkrc:pal Structure 520:
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<br /> Commercial/Industrial Structure $300 ,Addition/Alteration to Commercial/Industrial Structure $20'.; 5
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<br /> >Q. Accessory Structure(Garage, Shed,etc.)5,4).4•35TY: Aodition/Alteration to Accessory Structure $150 Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse •515C
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<br /> Deck/Stairs/Patio/RPtaining Wall/Sidewalk Bunkhouse $250 ! ,
<br /> Driveways/&Campground Structures 5125'• WI State Statute 59.692(1v)Structures 5350 7 V
<br /> Filling/Grading $150 Boathouse $500
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<br /> War Panels iStand alone or roof mounted) 5150 Permit Extension(1 Year Extension-Allowed Once) $100
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<br /> NOTE:After-the-faapeirriitsiiiinii acquired after construction has begun?may coit-t-Tp tothreet-imes ih rm e-noat fee 5.-----) ,
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<br /> Communication Towers, Camping Permits&Signs require a different opphcation form;see corresponding applicotron,and fees. 7 R
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<br /> "Items not listed above will be treated as accessory structures,such as:pergoras,landscaping, etc.
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<br /> Property Owner's Name. 5 co H t--/sc-hee- , tN
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<br /> Property ths-ncr'N\lading Add::-- 130.2S- (,0 40,er- ) e a tt.qi ./t 6/1. tri/V ss076
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<br /> 102-1, , i,..1,.' /ip ./t
<br /> Property Site Address. N;;Iti Pt et c Ira, / to4 2 _ _
<br /> 7ontact's Telephone Number &5.1 . SS-0• 9.5-Er3 a
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<br /> Amtaci's Lmail: con, .—D 5 k/5&11 e" /of. e5 , , , f , _ _
<br /> "If staff has a question about this application. you will bc ::onta0,cd :la entail. Make sure your email address is 7
<br /> egible and your email provider will accept entails from the following addresses qi,,Bumettfount org and 7 Z
<br /> a;13urnettCountyWI.gov =
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<br /> Legal Dcs:.•nptIon of Propert:!. /...0 4 2 5 Ai 5 / 0 fret, L ,19 P 4x._0_3 = w
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<br /> iection tr: , Town,4: 39 N Rangc / 6 v. 1,-,-.1,-.1
<br /> 'Attach additional page if needed for kngthy description OA'attach a copy oldie deed OR attach;,,x x-ystern property pag,- • .? , 7 :7
<br /> fax ID#(1.5 digit number; found on tax statement, 01.4elEc 3 e 6253 N
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<br /> 'roposed Use of Structure,Acidition: W C f
<br /> anticipated Start Date: illorm-Cahrri;Commercial Thisinc.cs;Hivienorn k:Dec err.) CAS (r
<br /> -3uildinv Contractor: SCV.c r In.tallcr:
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<br /> litEA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .-.-..:
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
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<br /> 4 Wr AO \43Z, US-tA - or \AWIYUk-v\ \IV-6 4-r)1/4 -i ::;'•
<br /> 7: E-cc Rec: Cf..C5)
<br /> •S'eR• aA4-acir\-QA ltk-k,r cIGLA- '°112-12532-- refi0-rcLi r " S4-0-ry Code_u
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<br /> )ita' of staff site sisit: I D1312:023 Initial of site s isit staff
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<br /> 1/41)PROVED BY 1.-k\11 :SEWS IC I s 01'VICIAL:_ DATE: 1,0 111/202S -.7 l-
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<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c gf g' rn 0
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .
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<br /> Burnett County. WI Land Use Application -- Rev 3/21123 ::. g ifird
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