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LAINI/ u3r, rr,icuvii 1 ArrL1l,A 1 iviv — riurnett county, W 1 <br /> r <br /> ,o ts <br /> Applicant Complete All Sections Below This Line °� <br /> a. <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) e c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "tki W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> /- Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r=, <br /> ' Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 r4 <br /> *NOTE:After-the-fact permits(permit squired 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. - der, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- <br /> Property Owner's Name: i\A 1 c h 0 t " J t an \.AfC1 I -}-Z 1 n C P <br /> 1 \ ,/ 0 <br /> Property Owner's Mailing Address:(`7 r) 5 S tClf e ?load. 35 (,()e.bs-fc VA' l 5 4ggj-g- <br /> City p o <br /> Property Site Address: 1,0 h i-1 -I-a i I 1 d c it 1)es_S 1 v Pa r <br /> Contact's Telephone Number: t7 15 -p(G(c> - 8 a r7to CelAr a <br /> N ° <br /> Contact's Email: �.t)h'1I t C."f Cli / U..)I tC'1t r i7e5S ' t rnCu I . Co►'1'1 E. <br /> , <br /> Legal Description of Property: I i1 C 1 Lt C\r CI N <br /> o <br /> 0 <br /> Section#: 3<.;\___Town#: ILO N Range#: f(Q W Town of: Ca I a n c Q N <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(l-5 digit number; found on tax statement): .36 a-?3 _ r„ <br /> --i --i <br /> Proposed Use of Structure/Addition: C.., p C' CO Ll Yea SI"(L�i r --1--0 ire w 2 <br /> Anticipated Start Date: 10)(T ec{i cute, --(YHome/Cahin;Commercial Business;Bedroom;Deck;etc.) 'V 5 <br /> \\) —i <br /> Building Contractor: /\//A Sewer Installer: <br /> 13 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COM.MENTS/CONDITIONS ONLY A 6N <br /> THIS PERMIT IS SUBJECT TO�� (v <br /> 11 ALL CONDITIONS LISTED BELOW: <br /> / �CeLJ a/l co.?a%i�ioHS �'Yvi i1 Ca 1a- Z!-/e. N.O <br /> z p <br /> x 9 Fee Rec: /Z, O <br /> Check#: 879e <br /> oT- <br /> Date of staff site visit 6 <br /> 0 Initi s of site visit st \)1---- v \ 1 CI-• - <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/87zeZz Q -1Eivil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - oCI <br /> Transcendent: - Page 1 of 4 3 <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 <br /> r <br /> b <br />