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LAND USE PERMIT APPLICATION - Burnett county,'1 <br />Applicant Complete Ali Seeds B; low I.in <br />Permit Types and Fees: (Please, check appropriate boxes) <br />uweiiing/Frincipal 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 />Six month Camping unit forte Per'yeml <br />i-tionlzartemOntoDweiling/Printipai Structure <br />ition/Alteration to Commercial/Industrial Structure <br />tion/Alteration to Accessory Structure <br />n/Alteration to Bunkhouse <br />$2ti0 <br />$200 <br />$150 <br />$150 <br />$250 <br />P$200Addition/Alte <br />house <br />tate Statute 59.692(lv) Structures <br />house$500 <br />mit Extension(1year Extension-AiloviedOr l <br />$350 <br />4�3nn <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 dfferent application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessary structures, such as: pergolas, landscopinq, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address- -71 Ara z�-h 4v6- <br />Property Site Address: <br />11G�7_ <br />City State <br />Contact's Telephone N,jumber: '77/5 3 3g 3/ <br />Contact's llnu&_ hCti'A n g <br />Legal Description of Property: 4)-r4C #C- D — P49Ce L zP 0-7- 020 <br />Section #:_ l/-7 Town #: N Range #:__J�W Town of: A k(-A /U P) <br />*Attach additional page if needed for lengthy description OR attach a capk, of the deed OR attach t= system property page_ <br />Tax ID #x (1-5 digit number, found on tax statement):_ /.36 <br />Proposed Use of Structure/Addi on: 5'a 446-r " <br />Anticipated Start Date: (� <br />-/ / ZGZ/_1`j (Nome/Cabin; Lontmercial Ru_ci„oss,, uea.•oo..,. ne..v. r.c.) <br />Building Contractor: S�L� Sewer Installer: NCJiVE �ti <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />— N mot----1Fd r IAu`vy\or� R4 i�tt c)(\ <br />Date of staff site visit: ? ? C_q7O /_? <br />APPROVED BY LAND SERVICES <br />of site visit staff: It� l— <br />Q - 9—r)611 <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SI <br />Transcendent: - <br />PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/201.9 <br />G <br />a <br />=13 <br />ID, <br />- W <br />Fee Rec: %rjQ_ <br />Check <br />a <br />r <br />z� <br />ti <br />