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LAIN', UM. rrJitivii 1 ArrL1t. .A 11V1r — urnett county, W 1 g <br /> Applicant Complete All Sections Below This Line F <br /> a. <br /> o <br /> Permit Types and Fees:(Please,check appropriate boxes) , <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "w <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> IP <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> fDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ,-..' <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 g) <br /> 2. 1 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. 5 .� <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r, J <br /> r 0 -4 <br /> Property Owner's Name: M(C.('h 0 e, - --.�ton \Ala ( +7-1 n ci - o , <br /> o <br /> I nn° ' _ <br /> Property Owner's Mailing Address: a 17 c a5 1 CI±e. Read 35 W e bs-Kv W Z 5 H-093-8 <br /> '' ,, \\ '' ''`` City Tate F. <br /> Property Site Address: W h I f{' fi a 1 1 W 1 C e r (�)OSS RL) ya r (gyp t'- — ' , ' <br /> Contact's Telephone Number: `-1 a ' <br /> I �� (c(o of`7So /�11C�� <br /> (� �\ o <br /> am?1 eta Contact's Email: C "1 I t� i / Ui I l C'I V'� - hejJ �0Ofi�1 Cli I co►'1'1 � \1p" <br /> Legal Description of Property: I tel C 1 t t C\ Ci N <br /> 0 w r <br /> Section#: 3 c9 Town#: 1 Hp N Range#: ILa W Town of: QG..K la i a 70 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Fi- <br /> Tax ID#(1-5 digit number; found on tax statement): --1�07 34 z93 6\ <br /> ' <br /> o m <br /> Proposed Use of Structure/Addition: Lamp r0(,l Y1 S{"rU C�`1)re- � W ;' <br /> Anticipated Start Date: ) l n edi ect-', Honte/Cahin;Commercial Business;Bedroom;Deck;etc.) 1 ^1 ° p <br /> Building Contractor: Ai/A Sewer Installer: — 1s\) <br /> -� <br /> 0 <br /> lll AREA BELOW TS LINE FOR LAND SERVICES STAFF COMMENT'S/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4 N <br /> z A �4 <br /> Qro/�o�, a ll cd`t�i'77vsTs w• c4P- z.i -/o, �H • � <br /> i\ <br /> H Fee Rec: /2,5 O <br /> Check#: g/9 8 <br /> 4 <br /> If (/ d <br /> Date of staff site visit: —1�U�� V Initials of site visit staff.��" I�-/ r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/Z4774e 2-5I rci 1- <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF „ n3. a C� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 60 <br /> o 0o N <br /> Transcendent: - Page 1 of 4 M 3 <br /> Laserfische: - Burnett County, Wl Land Use Application —Rev 1/2020 Zfl <br /> F <br />