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N <br />LAIN1) U NE YL' WV11 I AYFLIUA I MIN — Ilurnett county, W 1 <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />��)T,—C';s'ryStructure <br />(Garage, Shed, etc.) <br />150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 jPermit <br />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 timesthe 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 />Property Owner's Name: — <br />Property Owner's Mailing Address: P ,j`0 3-7Q <br />City State Zip <br />Property Site Address: alu 4q `A-ke J9,04, • 'zi� -.04 Z( t �✓� <br />Contact's Telephone Number: /oZ — 390 , / 73S' <br />Contact's Email: �,' �o_ _ 4k?--4 tL, <br />/gyp <br />Legal Description of Property: <br />Section #:_0!? Town #:_ QQN Range #:_ 177 W Town of. 1%.S" <br />*Attach additional page if needed for lengthy description OR attach a copy the deed OR attach tax system property page. <br />//of <br />Tax ID # (1-5 digit number; found on tax statement): G-?qip <br />Proposed Use of Structure/Add' ion: �4Ar l" � <br />Anticipated Start Date: 6 /1�/ � (Home%Cabin. Commercial Business: Bedroom: Deck: etc.) <br />Building Contractor: �nCe (I f�/1//�� Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />u s e C�-/ �d' li U wt a Pt <br />G/4— %b <br />Q' <br />�ew,V— - also Goers lPi 10x1& <br />Date of staff site visit: VA Initials of site visit staff: <br />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 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />i <br />d <br />CD <br />12 <br />CD <br />9 <br />z <br />0 <br />^n <br />0 <br />0 <br />o <br />n. <br />d <br />K <br />o v_Oo <br />5' <br />o� <br />d <br />0 <br />o � <br />C7 <br />y <br />z �Q <br />Fee Rec: <br />N Check #: <br />R A lid $/9 Lg ) 77L7 <br />N <br />cc <br />ry <br />0 <br />