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Jul. 12. 2019 8: 08AM Engineered Products Co. No. 1472 P. 1 <br /> LAND USE PERMIT APPLICATION-Burnett County,WY � r <br /> e ,ti <br /> Applicant Complete All Sections Below This Line 0 �o <br /> Permit Types and Fees:(Please,check appropriate boxes) C� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure S300 Addition/Alteration to Commercial/Industrial Structure $200 ^� <br /> Accessory Structure(Garage,Shed,etc.) 5150 Addition Alteration to AccessoryStructure $150 <br /> AccessoryStructure Commercial/Industrial $Z00 Addition/Alteration to Bunkhouse $150 <br /> Deck/5tairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 g <br /> Driveways/&Campground Structures $125 WI State Statute 59.692 lv Structures $350 r <br /> Filling/Grading $150 Boathouse 5500 <br /> Six Month Camping Unit(One Per Year) $1pQ Permit Extension(I Year Extension-Allowed Once) $100 `" <br /> NOTE:Af ter-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. po <br /> 'Items not listed above will be treated as accessory structures such as; er olas londsca in etc. <br /> �Q z <br /> Property Owner's Name: �/ / �� 5�' <br /> Property Owner's Mailing Address: 7Z ASaS Ile L 7— /U C . M1V S3rr7 b <br /> City State Zi <br /> Property Site Address: fP i/ �/1�f Oq �ti N Svc G.�� �30 <br /> Contact's Telephone Number:_ (� F/ <br /> Contact's Email: � ✓lSo� �y'�1 C �YJ(O • ��r'�1� <br /> dt <br /> Legal Description of Property:S-c cTta" ;17 7"ou*r/f/,�o �// rGov'7t�, R,�Se /S �T, /3�►r►ex� � b <br /> Section#: 29' Town#:__YL_N Range#: r W Town of: ,St✓;SS =0 <br /> *Ariach addfrional page 1f needed for lengthy description OR attach a copy of the deed OR attach tax system property page.; 5 <br /> 2 ! 3 <br /> Tax ID#(1-5 digit number;found on tax statement): �^7�T nn / ,�, <br /> Proposed Use of Structure/Addition: �ev oA w(7L �c , /(�/� o <br /> Anticipated Start Date: 7 a�5= (HomOCabin:Commercial Buctnesst Bedroom:Deck;etc.) <br /> Building Contractor: � /y�e C .—rwyafot. Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/C'ONUItTIONRONLY r N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r- �,'S e✓'�t7� /s {ter q )� ' x I D I ��r�©l4 ov�eir � _. <br /> � t t <br /> e)(Ire old c,�H�l� - i �o , �i's �5 4 vW741a / <br /> u ON Y71 USf �ct V e m e v1 5�� ,e �o <br /> ex P s l �/- <br /> e,�C�I/L°-2/V) 5 l.�/rti�JG�S (,C�4�15 ei�G . Fee Rec:--_�/ <br /> / w Check>;t:��9 <br /> Date of staff site visit: Initials of site visit staff; r � <br /> APPROVED RV LAND SERVICES OFFICIAL: DATE: Z f// ----�►---� c <br /> UPON APPROVAL: APPLICANT MUST:POST COPY OF y <br /> t^ <br /> c �m <br /> SIGNED PERMIT APPLICATION:IN PLAIN SIGHT00 <br /> Transcendent: Page 1 of 4 m�, <br /> Laserftsche:= Burnett County,WT Land Use Application—Rev 1/2019 <br /> y li ll <br />