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DocuSign Envelope ID: 17FC7421-22DA-4FDA-BAF3-20F1BC710623 <br />LAND USE PERMIT APPLICATIO', — Burnett ( uunt\. N1 I <br />Applicant Complete All Section,, Li:lov. I l:a L. nc <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Pnnapal Structure 5300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure S3f1 � Addition/Alteration to Commercial/Industrial Structure $2tx) <br />accessory Structure IGara e, Shed, etc.) S_' Addition Alteration to Accessory Structure S150 <br />Accessory Structure(Cornmercial/industrial) SAX, Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Fillip Grading -LL$15C Boathouse $500 <br />Six Month CampingUnit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $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 iisteed above wipbe treated as accessory structures, such as: Per vias, landscaping, etc. <br />Property Owner's Natne:Lk-wane <br />i . r �� tl T DC . <br />Property Owner's Mailing Address: <br />City State Zip <br />Property Site Address: TA 10 Cot AA+4A Qd �._.W � eiyw W T-_1;:Q6z <br />Contact's I cicphone Number: ��� ' p (oc-, <br />Contact's F mail:tY .. St1CY1 f1cY11 . CSM _ _ <br />Legal Description of Property_ QCL, `�S_ �� �" kiWV nst l til l o .� LAM 1 3q <br />Section : _ Town #:_39 N Range n: I L4 W Town of:_ Lb13kr <br />•Artuc•h additional page if needed fier lengd/ l- description OR ullach a rnrc• (y the drt-d OR drturh ret..ce,rt>,u PrnPertr P0s;r. <br />Tax 10 # (1-5 digit number; found on tax statement): 'N <br />Proposed Ube of StructurciAddition:�1Jt J�S{�1'�-� <br />Anti,-inge�d Cturt rhu.�,, ., —, o ,rr...... ..7 .,r,... II ........... .. r rr....,..,,. • 12-, 0- 0- a ... <br />Building Contractor: Sewer Installer: n/.& <br />AREA 111FLOW THIS LINE. FOR LAND SERVICES STAFF CO)1IIENTS/CONDITIQNS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site %isit: Initials of site ViAl staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent. Page 1 of4 <br />Laserfische: _- _ Burnett County, W1 Land Use Application — Rev 8/2018 <br />L <br />I i <br />Fee Re /SQ <br />Check 0: 93 <br />0 <br />m <br />a C3 <br />:23 <br />(D —� <br />c N <br />i� v o <br />s <br />