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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Annlirant Cmmnlete All Sertinnc Relow Thic Tine <br />AtChA BLEUW trill L1PIE rVK LA1VL .JEKV1l LJ JlAl r UV1V ME1V 1J/l V1�L111V1VJ V1VLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />S <br />Date of staff site visit: Initials of ite visit staff: �� <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DAT <br />UPON APPROVAL: APPLICANT M T POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />0 <br />0 <br />x <br />C7 <br />2 <br />CA <br />G <br />e <br />lry ti <br />z <br />Fee Rec: I <br />Check #: 1 i 3 <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 1 WI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading $150 1 JBoathouse <br />1$100 <br />$500 <br />Six Month Camping Unit (One Per Year) 1 IPermit Extension (1 Year Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fact 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 betreated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: CLA_ a�J A ��/ J P�Lk C R -ISC) �- <br />Property Owner's Mailing Address: 1 Q N i© s 1 L>t'_ A rZ Ltv T_ 14 5 <br />Z <br />_ }�. City , _ State Zip <br />Property Site Address: % �� w �' (_ ��V14a2 �1 (2Di�ti(�L�`�1 ius �J�1 <br />Contact's Telephone Number: DCA c W �Jk 1,A -gZ0 — L3 Z Z <br />Contact's Email: cAc-At.'d !pe -N -e -1-5c)" CASSgS bkgy. Com <br />O' <br />Legal Description of Property: Le> Q <br />Section #: 636 Town #: A ® N Range #: W Town of: Q #A 1TL14v, J <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: 5 A dZ 1Ay G <br />Anticipated Start Date: S A (Hoine/Cabiu; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: VLA eiLse}�k/ Lu, k j Sewer Installer: '"f~ <br />AtChA BLEUW trill L1PIE rVK LA1VL .JEKV1l LJ JlAl r UV1V ME1V 1J/l V1�L111V1VJ V1VLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />S <br />Date of staff site visit: Initials of ite visit staff: �� <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DAT <br />UPON APPROVAL: APPLICANT M T POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />0 <br />0 <br />x <br />C7 <br />2 <br />CA <br />G <br />e <br />lry ti <br />z <br />Fee Rec: I <br />Check #: 1 i 3 <br />