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o <br /> ;74 ..... <br /> 8.utot e Coq A 4'J.Welse pc,, , <br /> , <br /> Applicant Comp ete All Sections Below This Line ( i f 4 tJ <br /> 1 G <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> F", <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 74, Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <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 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 c <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ," <br /> tr.o (V <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. j <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> V <br /> Property Owner's Name: Le.5 L i E- / r,'t'l ec.?.(L LA kC.. _511 �� z `` <br /> Property Owner's Mailing Address: ` 997i CLi Ari/6Q-a g ' L.7NQ DR 4, SL:12y w/ z <br /> City State Zip c A <br /> Property Site 7Address: :Is c, 7I Ga-4'J Se-R.Ry C.At� darts r.y W, Sc1 g-5 s <br /> 3 <br /> Contact's Telephone Number: <br /> 9'5. -4f3G-- 96`65 c <br /> Contact's Email: L -n•ipl eeAzt.Al:e, 7.77 AJt....w-r) ' c_ <br /> RI <br /> GOT 3 r3;ci .5t41 vets 5M�,^'i/ ,•v pL4T (2-eco:co-e-o j -• <br /> px,:.m¢.r7' v.. .).acs S�7,t•'/ 'F42 i7 i CQ. i Rr:�:ss etL Ot <br /> Legal Description of Property: ©.z,,C!$ 0c z,rej-r C-t• '— 1.4'J5C - Sf"/ .1-..• <br /> N <br /> Section#: 3 3 Town#: N t N Range#: 1 Z W Town of: 5w i S 5 - or,. <br /> `Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* t <br /> Tax ID#(1-5 digit number; found on tax statement): x.55 3 <br /> Proposed Use of Structure/Addition: W a i4 t ct� S r..,r..ie t `� <br /> � <br /> Anticipated Start Date: 03 - 1 s''• ...(72-1 (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) <br /> c <br /> Building Contractor: Skkeret Fill Leri f3ej, t 4%:: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: N dl <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured z V\ <br /> home additions,and bunkhouses.** / / I 73 <br /> V A9#91— 4 (1se U5 ed 14►^ Au riapl kaLt `��4 r \.1J3 <br /> iv7i^N fel 10eCQ' 47 Bl•�1461/I 45 rt�DUNIGtI/IOUSC,itIS I� 1 <br /> npT e.41 as /c� ,�I 14 (k11d dse) , T 6c.. Us(I — coo <br /> P /_ J f 0 -' Fee Rec: t <br /> Q iY G S q SNS' .... <br /> , .... Check#: 13a5 <br /> Z. Zoz/ / u <br /> Date of staff site visit: Initials of site visit staff: / G ,�� z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z3 ma/ < t--J�' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' <br /> to CS <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r- m 01 <br /> Transcendent: - Page 1 of 4 2. c <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> a <br />