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LA1'U U E rL' KIV11 1 AYYL1l.,A 11U1' — Burnett tounty, WI a <br /> Applicant Complete All Sections Below This Line 1 g N <br /> a @- <br /> 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) a X) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 .2 V,1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W 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 /> MP <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a • <br /> 7. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- I <br /> ' Filling/Grading $150 Boathouse $500 0 <br /> ^ 1 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 cn <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 1$' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. -moo <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I— <br /> *Items <br /> z <br /> Property Owner's Name: y + `f- J ' n a -F Z a <br /> 1 °o '` <br /> Property Owner's Mailing Address: o)17 t J tCti-e f-2 W 10 ad 35 e,b tcv VI__ 5 40—, <br /> City F.. 6 <br /> Property Site Address: Lk)h 1 f tat 1 u t Id e ir- 1�eSS R v va r La--I-`'-'- A3 <br /> L/'v,G� A 2 <br /> Contact's Telephone Number: ` 1 15 - '(a(c, •- s 3'7� ,_ 1 <br /> N o <br /> Contact's Email: C,Or-)1 f e to,t ) 1 la-c if 0e5.5 �.hOfi flat 1 . Co r1'1 ' E <br /> Legal Description of Property: I tl C la C1 t ci N %.t <br /> Section#: c9 Town#: 1 140 N Range#: J(o W Town of: oaK I a r G{ N <br /> "� <br /> *Attach additional page tf needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): to z?3 <br /> Proposed Use of Structure/Addition: C_c r r ..J CO Ll nCt S[YL.) r f(�re_ W o <br /> Anticipated Start Date: -r)meat ct-1-(e, Home/Cahin;Commercial Business;Bedroom;Deck;etc.) s N p <br /> Building Contractor: fv/A Sewer Installer: — HIto <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 Q <br /> GG /THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0fe;/low a/1 co ifd�rr-/m1,4 . -1,tAn GIA /0- Z/— /0, zN <br /> z 0 _p <br /> 0 1711'S 17�— m-/e-e15 4 he- mo ed 4 /°// av hit)if — ( C..) <br /> /j e- 174,0,15 /A/0 Co tnn f/1 a/46e_ - r Tel s/Z e_ /1'IAA t V--s, <br /> .-, Fee Rec: /Z,529° <br /> N Check#: g'/qS''' <br /> 7. <br /> h2t: <br /> �0: mDate of staff site I w � Initials of site visit staff: �^ ��C` <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 3/Z9/Zo 241hl <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF *i w n <br /> SIGNED PER <br /> MIT APPLICATION IN PLAIN SIGHT -'Fi' <br /> N <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2020 ; - <br /> m ! <br /> C7 <br />