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U <br />T APPLICATION — >tsu <br />Applicant Complete 11 A11 ll Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate <br />Dwelling/Principal Structure <br />Commercial/Industrial Structure <br />Accessory Structure (Garage, Shed, etc.) <br />Accessory Structure (Commercial/Industrial <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />Filling/Grading <br />U t (One Per Year) <br />boxes) <br />$300 Addition/Alteration to Dwelling/Principal Structure <br />$300 Addition/Alteration to Commercial/Industrial Structure <br />$150 Addition/Alteration to Accessory Structure <br />$200 Addition/Alteration to Bunkhouse <br />Bunkhouse <br />$125 WI State Statute `_ <br />$150 Boathouse <br />Linn Permit Extension <br />Structures <br />Year Extension - Allowed Once) J$100 <br />Six Month Camping m <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*crams not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />lTd <br />T <br />Property Owner's Name: <br />k,jj -T .. S49 4T) <br />Property Owner's Mailing Address: r A City t State Zip <br />Property Site Address: <br />Contact's Telephone Number: <br />Col a - QS9 �3 <br />Contact's Email: t C -` ?'�- A) <br />.J <br />tJ(57 eg a4'� <br />Legal Description of Property: Lbi <br />C3 <br />Section # Town #: 13-7 N Range #: _.!EkSkjJW Town o£ ►py-JA�—�- <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: 5ec-� <br />(Home/Cabin; Commercial Busines Bedroom; Deck: etc) <br />Building Contractor: Sk��`� `t'`, a"-`��-�S Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />r- � -An u� -4r xu>�0 ti4�� �tv <br />NP1, <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />r <br />ro <br />y H <br />O <br />ti <br />0 <br />o " <br />0 ^ <br />o <br />a <br />0 <br />o d <br />z <br />x Fee Rec:$� i�- <br />y Check #: <br />0 <br />rn <br />r <br />Y _ <br />C <br />N 0 CO <br />C <br />