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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: jPiease, check appropriate boxes) <br />Dwelling/Pnnapal Structure f $.SW _ Addition/Alteration to Dwelling/Pnnapal Structure $,zw <br />Commercial/industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />AccessoryStructure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Natio/Retaining Waii/Sidewalk i3unkhouse $Z50 <br />Driveways/ & Campground Structures WS 1Ali State Statute S4.692(1v) Structures $3517 <br />L lHiling/umaing I y15o 5 It5oathouse I $Suu <br />Six Month Camping Unit (One Per Year) 1 1001 IlDermit Extension (1 Year Extension - Allowed Once) Isloo <br />*NOTE: After -the -fad permits (permit aquired after construction has begun) may cost up to three times the normal fee. <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. <br />Pronerty Owner's Nae: yl`nQi 7,-u s+ �ce <br />Ttx [ <br />m�E+s <br />Property Owner's Mailing Address _NQ QOx 3 3 W) <br />�i 1% State Zip <br />Property Site Address: q 6;Rtkno Pl�ICY{ <br />4 -quail a 076 5) <br />Contact's Email: G� b& i970 G3�Fn2 l , eeyn e -,r- c� /aoY i-( 5 <br />Legal nPsrrintinn of Prnnr'rty 10 }" i C S M H 7 ts. 8 J • �1& P. 2 50 <br />Section ii:_ %� _ Town #: 318� N Range :___L5 ini Town of: Fv Ile � <br />*Attach additional page ifneedeil for lengthy description OR attach a cour of the deed OR attach tax st stern prnperfi page. * i <br />Tax ID # (1-5 digit number; found on tax statement): 34 8 249 <br />Proposed Use of Structure/Addition: (; a,,,4 1384-t-, &Aa .4 ea 6r`� ► <br />Anticipated Start Date: !mac •I- 2d I (HumelCabin; Contmerciul Business; Bedrrwm; Deck; etc.; <br />Bm i din u i oncractor: sp r� Coy �S {n[G� t ars T.nC Sewer instal i er: �(3� (Zct 7fs h v l m <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />x �� S i r\ s v S <br />- <br />9 ��� __ s� <br />Date of staff site visit: Initrats of sit visit an: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE: <br />TTT%4`%1kT ♦ TUTf"!\T T ♦ T _ ♦ IMIMW T!" ♦ I\TT It MYTC`1T T)/1CrT /'illTlt T /lT <br />Urv11411 H.rrimmVI-vu I-XrrI-jlul-vi•lI iviu,l r"1:51 %1"r t "r <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Rnrnett Cannty; WI I,nnri ITce Annlirntinn — Rov 3/26114 <br />k <br />i � d <br />i Ef ! <br />OG <br />oG <br />z ! C) <br />i CC RCC: 00 <br />