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LH1rli u3r, rr.itivii I tirrLll,,,k I IV1•l — nurnett l.ounty, WI a D <br /> Applicant Complete All Sections Below This Line & g. N <br /> Permit Types and Fees:(Please,check appropriate boxes) 7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " N <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 kO <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 /> c) k • <br /> 7 Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ; r► <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. p <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -o <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> N \1CVA el Jt'an \ila. I +�i n 44 <br /> PropertyOwner's Name: v `(" C1 ` '/ -n <br /> Property Owner's Mailing Address: c '7 t-�c 7 to-{-e - o ad 35 1,0e_as5-icy �N Z 'J 409 r a <br /> Citiatio �n„ <br /> Property Site Address: (���I r t Gt I i �[� V (�eSSL� Pa ‘ 11._ � <br /> Contact's Telephone Number: 1715 -p, (c(c' - e al'70 ' <br /> o <br /> Contact's Email: C.Ch I t e-I Cu I u_) IC'1,°( i')e.SS @.0Ot CflCU I . CO(Y) A.1 <br /> Legal Description of Property: 1 r1 C 1 t.t CI C Ci o " <br /> 8. <br /> Section#: 1) Town#: 1 HO N Range#: J(P W Town of: ()CO1<1 a r '( o N <br /> c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number; found on tax statement): r- — - G z9 3 - <br /> Proposed Use of Structure/Addition: Laxly C(O Lk n a 5frL) c'f O v e G <br /> F <br /> Anticipated Start Date: )�Y1(1lPL�t C(-I-C, Home/Cahin;Conunerc•ia!Business;Bedroom;Deck;etc.) i ^, d <br /> Building Contractor: AVM/R Sewer Installer: ` S ) b,- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6\ <br /> 61' �O//e.t,) d/ GoLl,4540 , 4,0, , c u P-ai-/Qe z -0 N <br /> 7.Qeck/9q z_e40 40 be re u /n Sizes I)ea^ CUP-Z! -/0a 6\. U1 <br /> g e,r lleANIS are 4/4 <br /> 9 we.1 4 s^e tAAct 1 h ' 747 IA e y GIV_ <br /> Z. <br /> Irep4lrec o eeicreeO' w,U s71 `7`(e✓I iA4 tei 4 ,'Ze �I'Kn, , H Fee Rec: l Zy�v <br /> Check# g/�} <br /> �� 0 " <br /> r j r .41D m <br /> Date of staff site vi (( Initials of site visit L � r <br /> z , <br /> yI <br /> 0 <br /> r <br /> ti <br /> APPROVED BY LAND SERVICES OFFICIAL: _2" ` DATE: 3 Z$ zeZ� m E -- Effi <br /> UPON APPROVAL: APPL . ANT MUST POST COPY OF r W <br /> yam. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ^, <br /> Transcendent: - Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application -Rev 1/2020 rr,1 l\ <br /> --t <br /> y <br /> -o <br />