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LAIM ) USL YLKIVII I AYYLILA 11V1r — 1Surnett county, WI a <br /> Applicant Complete All Sections Below This Line R <br /> o 1 <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> u <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200ti <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 V o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> !U <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> , Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �=. <br /> f Filling/Grading $150 Boathouse $500 110 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 , <br /> o <br /> *NOTE:After-the-fact permits(permit aquired 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. r-, 2 <br /> r f/ r 0z <br /> Property Owner's Name: c Y l Q e.I —4" .J an via I +7-I (rl 9 <br /> ` '/ 114 <br /> o '\ <br /> Property Owner's Mailing Address:al.-L Stai+e- Pic act 35 Webs-�f V�' Z 5 4'B9- , <br /> ,, `` \\ a n <br /> Property Site Address: W L I i--�to it W 1 Id e V- 1)c�S f'--W v City t ^t`ate ' <br /> l�C1 <br /> p 7S a'1� <br /> Contact's Telephone Number: I 5 -�, (cCc� - a <br /> 0 <br /> Contact's Email: L.k`h i t e-1 Cl1 I u.)1 1Cl t it n(SS '�but nrlai I . CO►"I'1 , r <br /> Legal Description of Property: I rl C\Lt CI r'c/ N <br /> on 'I' <br /> Section#: % 3 Town#: 1 140 N Range#: Jtp W Town of: (Ou..K I a 11 ri o N <br /> *Attach additional page if needed far lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ) .-TC) 95 36 z/g3 <br /> Proposed Use of Structure/Addition: C.,o,n-yR COD. r)Ct S t r C`-I"o✓ . W ° 5 <br /> Anticipated Start Date:_K1'it CC.l C'(-re, Honte/C'abin;Commercial Business;Bedroom;Deck;etc.) I c\Jo p <br /> Building Contractor: /V/ft Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N <br /> 7, fi'/ot -' a(/ c�r� oers -�vnrAt CuP- 2-I-to , z % W <br /> z, <br /> 6\ <br /> Fee Rec#12 <br /> Check#: t <br /> i u <br /> Date of staff site visit: 1 ( --3 Initials f site vi ' ff: t+"\ r- <br /> � <br /> 2 C <br /> cn <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: J Z7 ZOZV in <br /> cz <br /> liffil <br /> UPON APPROVAL: APPJ1CANT MUST POST COPY OF C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N lithl <br /> Transcendent: - Page 1 of 4 <br /> A. <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 1 •ro <br /> 11f <br /> H <br /> LL )J <br />