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LAM USE PERMIT APPLICATION -Burnett County, WIFf <br /> R I s <br /> Applicant Complete All Sections Below This Line <br /> �I <br /> Permit Types and Fees:(Please,checkappropriate boxes) (A d <br /> Dwelling/Pfincinal srructufe 5300 AdditionlAlteratinn to nwelline/Principal$tri1 !*e t2nn �` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 OQ O <br /> .AcceCSnn!$trli('t11fP{ afaaE',Shed,ptc.) .$150 .A�r!itIenlAltafElti4^tti Accessory Structure <br /> Accessry Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/RetaininpWall/Sidewalk I I ,Runkhouse -5250a� <br /> Driveways/&Campground Structures $1251 IWI State Statute 59.692(iv)Structures $3S0 i r. T�►� <br /> Filling(Grading $150 !0oath"'se { <br /> Six Month Camping Unit(One PerYear) $1001 nsion(I Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. <br /> *Co m.munication rowers&5i-+ns requirea differentavo1kation form:see crorresnon din a aerlica On-n.and fees. � G <br /> *Items not listed above will be treated as accessary structures,such as:pergolas,landscaping,etc. 1 <br /> Property Owner's Name-- ��� -Fili1 N1 l--`� co b 0'ON <br /> Property Owner's Mailing Address: �. ° X <br /> I I <br /> -4 0 n 9 r p D/� city stare <br /> i rnrle 11 Y .ciitc Address- �C.Iti ♦r-4 l rV 1 7AC�J D�taN P51.1 rLIr <br /> w <br /> Contact's Telerhovle iVwnber- Le 1 9 O <br /> I zo i <br /> Contact's Email: <br /> i.egai llescription or rroperry: l(2-- 1 4 b D i"r I Q W —it' <br /> Section#: Town ff: N Range tf. w 1 Vwll of Y <br /> *Attach additional page if needed for lengthy description OZattach a copy of the de attach tax system property page_ <br /> Tax 1Ia 9(1-5 digit nionlic;r, hound im iax sialcmt,-1101_ <br /> Proposed Use of Structure/Addition 2— �G <br /> Anticipated Start bate.'/ 1q���-_� * i_ 41ome/Cahui,Commercial BiLunec�s,(Bedroom.Deck,etc.) 11 0 <br /> L Ullt°4l�VVLI- V♦Vi. /� V4YI�r♦ •i.:.Lfl1lV1• , <br /> .AREA BELOW TAIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (Y� ! o -�ob� sae �-t � ��w• t01TS--7 <br /> 1 I l I <br /> 1 <br /> 5 Fee Rec: = <br /> ri <br /> Check# <br /> LAIC Vl J[itll Sl[C VLllll. V � Ill/lli[LS Vl S1tC V1Sil,[Alt. � <br /> APPROVED BY LAND SERVICES OFFIC DATE: w <br /> Try\l��T ♦ i T ♦ T� 12T A 1%Try �f?�TIVT 'I--- �T1 tV�--1k'% �.T- � � C. 3 <br /> U FOIN AFFRO v Al,: Arpi-Ak An I IVIU S 1 rVno I UOr Y Or <br /> Y A CD <br /> jll Nl D YERM-1 A Y YL1CA l LNI 10?N L -1IN J1lTH"l c, C" <br /> 00 <br /> Transcendent: - Page 1 of 4 ` cc <br /> Laserfische; - Burnett County--WI Land INe APnliention-Rev 1/2019 <br /> ib <br />