Laserfiche WebLink
q <br /> EC ENE <br /> MAR 2 4 ZFL5 <br /> LAND USE PERMIT APPLICATIO $uj- . a �i ro <br /> Applicant Complete All Sections Below This Line c <br /> a <br /> Permit Types and FeestPlease,check appropriate boxes) 00 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,\ <br /> .x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk IBunkhouse $250 < <br /> Driveways/&Campground Structures 1 $125 jWl State Statute 59.692(iv)Structures $350 c <br /> Filling/Grading $150 lBoathouse $500 ^� <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> iv <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> z <br /> o � <br /> Property Owner's Name: i'�/l /4 r �'� <br /> Property Owner's Mailing Address: S S X A- -e fit) Lit d ir (,,A � A 114/v w <br /> City State Zip <br /> Property Site Address: <br /> Contact's Telephone Number: 7 j—7 L o <br /> Contact's Email: t^' A-v L o t" <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov <br /> Legal Description of Property: <br /> Section#: 13 Town#: N Range#:--I I _W Town of: N(kwc 44 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propert),page. <br /> -// 70 k <br /> Tax ID#(1-5 digit number;found on tax statement): A-,-0 .'e Of. r T 31p95? W <br /> d <br /> Proposed Use of Structure/Addition: �1 /� A ) V <br /> Anticipated Start Date:1 5—AA X y (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: /t- 0 - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYOD <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> A <br /> O gE- ltSGP BIZ 1i'UwVHV I},c)t�IT13TtON <br /> es5 8� 5�15�Zozs- Fee Rec:� <br /> ® HPt;L^I Foa' f}n0R 0 Check#:337 <br /> Date of staff site visit: t{I300 2S Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: _ DATE: Z°ZS <br /> UPON APPROVAL: APPLI ANT MUST POST COPY OF <br />