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1Jti1v1/ u3r. rr.ruvii i ivrrLik.,ti i tun — i urneit county, wt. a 3 <br /> % T b <br /> Applicant Complete Al! Sections Below This Line I N <br /> d <br /> Permit Types and Fees:(Please,check appropriate boxes) �, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Ti. <br /> Accessory Structure(Commercial/Industrial), $200 Addition/Alteration to Bunkhouse $150 N 3 <br /> n a, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° k1 — , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c=. k <br /> Filling/Grading $150 Boathouse $500 <br /> A <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 i; <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E _ <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. t— <br /> o <br /> Property Owner's Name: N 1[CI e I "1" -J ton \ila. I +Z) Yl <br /> Property Owner's Mailing Address: o� I c a-I t - 'L f 10 ad 35 U)eb$ VI- 5 1-1-075.5- <br /> I ,i Cit -- State - i n E <br /> Property Site Address: LID h I-1--C t a t 1 W 1 Id e V'- (Jess R LI Ftt r L.6—t- -* <br /> Contact's Telephone Number: `si 15 -p cc(,-, - F,9-1s, Ze#e- <br /> �,I s Viol- I . Corr Contact's Email: C�� � eta i I l�I lC'I�a i7�.» -. � <br /> ,•Legal Description of Property: I rl C 1Lt CI 2'Cl o w <br /> Section#: 3 c.Town#: 1 1-}Q N Range#: J(p W Town of: C)u K)a t-i c( d N <br /> *Attach additional page if needed jOr lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number; found on tax statement): J( 3 <br /> Proposed Use of Structure/Addition: C.0._1'1�P 1' CO LL n d Si"rL.)0-I-0 Irk yJ <br /> Anticipated Start Date:_la)fned(GL-i—e, ' Home/Capin;Commercial Business;Bedroom;Deck;etc.) 1 N ° j <br /> Building Contractor: Ai/A Sewer Installer: r -� <br /> AREA BELOW Tu LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Cts <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 6/4- cal/ cord A ines ' 2w. C t1P-if-ID. z s `0 <br /> ;61 AN <br /> -i Fee Rec: (Zi S C' <br /> N Check#: 2 i?8 <br /> rn <br /> Date of staff site visit.4 ` 3' e -", )C) Initials of site visit staff: P,14- <br /> r <br /> P <br /> Z. <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 3/���Z'tf r, l J <br /> < r <br /> Hil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF u; a� X <br /> 5 a 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c Nil <br /> � o� IV o <br /> Transcendent: - Page 1 of 4 R w <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 L7 2 <br /> Rp. M <br /> v <br /> ) <br /> ro <br />