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AND USE PERMIT APPL CATION — Burnett County, NVI <br /> Applicant Complete All Sections Below This Line <br /> a <br /> C7 <br /> Permit Types and Fees:(Please,check appropriate boxes) C)"1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `� CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 Wl State Statute 59.692'1u 1 Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red 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 /> *Items not listed above will be treated as accessory structures,such as;pergolas,landscaping,etc. <br /> Property Owner's Name: Dale-4 OhLCUI ®0! /()H z <br /> -T, p <br /> 1 8 <br /> Property Owner's Mailing Address: /7 Ore /(�✓ � 9q <br /> City State Zip <br /> Property Site Address: DQ�Y►�ll) <br /> o � - <br /> Contact's Telephone Number: 7/5 y q I' 0 7 3s __ c <br /> Contact's Email: d ak !� 'Mold/J < 4`4 In <br /> Legal Description of Property: Sbo I ao <br /> Section#: Town#: N Range#: j,5 W Town of: 01() <br /> t7 <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:I et�n i b on 1��/Y//' G LY rd F x <br /> Anticipated Start Date: p (Home/Cabin,,CommerWal Bt iness;Bedr m;Deck;etc.) o p <br /> Building Contractor:s ('JZL l-05-501 Z Sewer Installer: "� �AREA I3E;1,OW THIS 1,[IN F FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY � <br /> THIS PE:RNIFY IS SUBJECT TO ALL CONDITIONS LISTED RI-:1 ONN ; <br /> z <br /> Fee Rec: <br /> Check#: <br /> Date of staff site visit• ` Initials of site visit staff- ` a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: <br /> 1 ( "• `I "1 <br /> UPON <br /> APPROVAL: .c � 3 ,r ' . l ' SM ; ` F <br /> me m <br /> SIGNED PERMIT' I`I" APPLICATION I IN PLAIN I HT 0 <br /> C N C, C" _ <br /> Transcendent. Paue I of 4 N> <br /> _ � w w o <br /> Laserfische: - _ Burnett Cot no. N% I Land E se :application— Rev 1/2019 <br /> CD <br /> Igo <br />