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_ Rurnett C <br />Complete All Sections Below This Line <br />Applicant <br />+ Permit Types and Fees: (Please, check appropriate boxes) <br />Addition/Alteration to Dwelling/Principal Structure <br />$2� <br />Dwelling/Principal Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$300 <br />Commercial/Industrial Structure Addition/Alteration to Accessory Structure <br />$150 <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />$250 <br />Accessory Structure <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />State atute 59.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures $10 Bolathouse <br />$15 <br />$500 <br />Filling/Grading <br />Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension -Allowed Once) <br />$1 � <br />Six <br />after construction has begun) may cost up to three times the normal fee. <br />*NOTE: After -the -fact permits (permit aquired <br />a different application form; see corresponding application, and fees. <br />*Communication Towers & Signs require <br />*Items listed above will be treated as accessory structures, such as: pergolas, landscaping; etc. <br />not <br />Property Owner's Name: , � t t` "i' A <br />Property Owner's Mailing Address: `Z.c. i Z-- S '4�0 <br />State Zip <br />City <br />Property Site Address: 2- j Ce4- Pt - O 3 t "tz <br />Contact's Telephone Number: `i t 'S ` `4 e� 3 - z (c Z- 4 <br />Contact's Email: �t , t��� �" i S-T t IP (-' Olt fa <br />Legal Description of Property: Z� �CS� / 70 <br />Section #: l Town #: N Range #: j�i W Town of: Zi a ram' e t- C <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): 2 Z 2 S- <br />Proposed Use of Structure/Addition: A k Q oXA, J_ <br />Anticipated Start Date: -S --� N £- (Home/Cabin: Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: I— rk � � � ' � � L_ � r= D'3C A"?" ewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/ Initials of site visit staff, 27L <br />Date of staff site visit: �( <br />APPROVED BY LAND SERVICES OFFICIAL:7gDATE: / �9z <br />- <br />UPON APPROVAL: APPLICANT MUST 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 1/2019 <br />N <br />ro <br />� b <br />a. <br />o <br />r� <br />g_ <br />Q <br />o <br />v7 <br />o <br />z <br />0 <br />t <br />o N <br />c <br />a <br />d <br />`0 <br />ao <br />V) <br />o <br />f <br />� d <br />z ( N <br />�vv <br />Fee Rec: <br />Check #:� <br />w <br />a <br />ci 0 <br />N o <br />00 <br />M <br />0 <br />s�.J <br />a <br />css <br />h <br />