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LAlNll UJl�. Y1LK1V111 AYYL1l,A11V1N — 1Surnett k-ounty, W1 a <br /> Applicant Complete All Sections Below This Line ' <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> cial/Industrial Structure $30 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure 00 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 of <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �. <br /> Filling/Grading $150 Boathouse <br /> $500 <br /> Six M mpin Un ( e er Year) $100 Permit Extension(1 Year Extension o $100 <br /> OTE:Aft -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. �o <br /> * uc ures,suc as.pe <br /> qA z <br /> Property Owner's Name:_ <br /> Property Owner's Mailing Address: l� �►\ ��1 g <br /> City State Zip <br /> Property Site Address: (to -.Ea4 "�j �� &iA t <br /> Contact's Telephone Number: �1�� ' �j,3 at3 aci Q <br /> d <br /> Contact's Email: NAX-NPAELLVIYl'- jt%1j'VkA\L,�[�1� <br /> Legal Description of Property � I �g� �b3 Z�j o <br /> � <br /> Section#: Town#: N Range#: W Town of: �,,,1►- <br /> 0 <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 stateanent): ocl T <br /> Proposed Use of Structure/ dditio )—A n Q(t ,4, J4 flo �TA 1( A- ,AeA ° x <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) tj <br /> Building Contractor: 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 /> cs�w�r`r� 1�mZ�ed -F-o -3o c-c (e►2chr f I <br /> ;w\-001. vimbwr er� - <br /> s Fee Rec:Zap _ <br /> S��l Check#: <br /> 0 <br /> Date of staff site vi 't Initials of site visit staff. <br /> APPROVED BY LAND SERVICES OFFI E: ( � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r- <br /> Transcendent: - Page 1 of 4 00 <br /> CD C <br /> co <br /> Laserfische:_ - Burnett County, WI Land Use Application —Rev 1/2019 <br /> m CC <br />