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1,AN11 1.:SF. PERMIT APPLICA I ION -- Burnett t't►uutr, WI <br /> Hi 7 <br /> Applicant Complete All S.•'t:tionh Below This Line -- <br /> = i r <br /> Pcrm t Types and Fees:(Please,check appropriate foxes) ' <br /> waeliiri/ r rcpal S:racrure 5307) Add tin VPIte•'aton to Gatetz1I igiPr rrc•pl5tru_iure � '-' <br /> cwnrnrrLidifIndt4:rid51ucttre $3Ct7 'Add toniAlterationtoComm•arclaiflnduitrial5tructure 5200 ` � � <br /> Accessory Strac:ure?,Garage,Shed,etc.; 5150 Additior/,Alteration lu Accessory S:Tac:u•e 5150 ., <br /> n <br /> Ac�e55orY5rr;c:ure(CCCr'tnernal/ndu;u'i]J 5200 AdditioniA,:eratiran to N.nt:hou;e $:5t? 1pun <br /> Deck/St3 Ts/Patio/Reid,nitig V./all/Sidewalk Buf'OUJSi: 5250 �(�t� <br /> '.Driveways./&Car pgr•.t.r z Stru�t•..1.es. 5125 Y: 5t.:;e Statute 59.59211v!5l•uch.re: 535C <br /> lam_ <br /> — I it,rtgiGtadrrg 5150 _ Boathouse $SOC — <br /> Six Month Camp, Jr.::(One Per Yes:) 5100 ( <br /> % Peru t Extension(I Yea•Extension-AtioWea 0,:.F) SII I_ <br /> .NOTE Afte�-the-far pernits,:permi:squired atter tenstn,,t on has aegunl may cost up to three times the normal fee. a <br /> '(nrnmunirntino roti•eac&Sigrc regtr.re a eietrent apprico:icr form;see corresponding application,and fees. 5 fin- <br /> 'items Mt Ated abolle Win be'tren rod AK Or i PS wry crfortim <br /> m1'itemsrint;IStedatnvevnrlbetrenrodncnrrPSwrycrrnrtinc i c-hac perg. 'ai,oar(istcpt%,etc ti 1 <br /> Property'Owner's Name. S-t,5:.F _ 4. fr?.'5 54 { 14 l t2„-(4_ z <br /> P 1 .r. 23T '�, <br /> Property Owner's bfailiag Addtr«rx: 4-16 it' )_t,lj�° �-�ne t��i L�.th t _ /ti) <br /> y� �� -TO � <br /> City tBiC Li. CO f <br /> Propene Site Address: ". Si Dt'at1 1 e 1,/ _ 7 <br /> I onlac.t's 1elcphnr-c Numhcr:____ (Q STI, " ZS' 3 ' 5 d 9 — ,. �� <br /> G <br /> P. <br /> Contact's Em1.il: r-rAt trtdle, /'eD ►Y>.‹./.„) 12JH_1 <br /> 1I 2 !{ �) r <br /> Des; <br /> :r ecul Drr poem of Propel!. L Q [JP' t/'- 4 f/"�Qf_ I <br /> S.�riion ' Town : \Range : I 11' lcst4n or: QAC LB1 <br /> tArrucir rukirr;oanr ocks c..a,.rdrti for/eni et-lestrpti•ua JP.ranch c,cora)oft e heed UR:naafi tat sys'c•nr p.'opev:I pave ' <br /> Tat IU r(1-}digit number-;tcund on tat statement) 1 9 t--1-2.q._ :-.• <br /> • <br /> Proposed <br /> l - <br /> Proposed Us of St-uciure.Additi +�10beft LtJtnl y_ fA.ad-'E E .. rOI?L t 4- AC�. Ir" <br /> Anticipated Stan Date g {J j (Ntonr•i'ahir, oaanercrru teMne c trc'.irrtnrgMeet:et:1 I v <br /> ji ----- G <br /> Building Contrac:or Jc4 � �1 �3��r SOt_J 'eLSew- ttitnll•- r�r1G- <br /> — <br /> (161AREA BELOW THIS LINE FOR L.L!SI)SERY(C'ES STAFF COi4MN1E:STS/CONDITIONS ONLY i <br /> 1'HIS PERMIT IS SUBJECT TO ALI.CONDITIONS LISTED BELOW: <br /> Tar'eppiir'unr need.In enn,nwr their t Lit In.yaeeti+r to determine if,a permit io needed Jinn;them prior to <br /> IN t rnncrrurlion taking plate jar urn tia,riling%,dwelling additions.rrrnnufartured larnnps, rntnufarYfld z <br /> inane defitir►ns,and hunAkrne.ws_'�' <br /> 1 e a lI Sekb4tc41,_ f p-- <br /> weee nod' Jv exceed 3 beta'X15 0e( 5a 1i <br /> P <br /> -_ - ,0bP <br /> Fee Ree: <br /> - Check a: ii Io 2 <br /> Date of staff site visit: 7/2!�]l/�1 Initials of s' a visit staff: t/—.... <br /> ✓ <br /> 7/4I'I'Ir ►� EDICY L Vt)st:I��Icrs orrfclAL: �,, �� u:�I> . �_.�.,__,J <br /> UPON APPROVAL: APPLICA -'MUST POST COPY OF f a Fit <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGIIT3 <br /> Iranscertdrni: - Pauc I of4 w .�- Nil <br /> Lacertiechr: Burnett County, WI Land Use Applicalinn—Res 1212020 co I e.., <br /> 3 <br />