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\A <br />G..v*c <br />wV, <br />LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure f$2 <br />Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />AccessoryStructure (Garage, Shed, etc.) Addition/Alteration to Accessory Structure $150 <br />$1- <br />AccessoryStructure (Commercial/Industrial Addition/Alteration to Bunkhouse $150Dedc/Stairs/Patio/RetainingWall/SidewalkBunkhouse $250 <br />Driveways/ & Camp round Structures WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading 1$1501 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) 1$1001 jPermit Extension (1 Year Extension - Allowed Once) $100 <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 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: Q w,F' nyV no1S <br />Property Owner's Mailing Address: ' cl <br />City � ` State 7a <br />Property Site Address: L -)� �ly i 1 ")� �� F-- ��Ln I `, t <br />Contact's Telephone Number: C <br />Is - <br />Contact's Email: r-. 1"1 VVC> u. S(G; L i Ll (l ti 1 <br />—F <br />Legal Description of Property: GQ lv , V 612. c, A 1Zt_ i,01 <br />Section #: 1 3 Town #: f D N Range #: 19 W Town of SG(_j(.Sz r-) <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): fvd g - <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: I' (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: /a Sewer Installer: r> I <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Th',s a.T fogad '(5 r\<)+,3.r, 4- o-+ <br />�-lol-, o„t, <br />\ ,,,.r a.Ar, M <br />+\(Nc- A;, k� �!3 �' b/e c?z v cres�t� �i'o a ?" Dlx�i r 4QN 5 J %A't .5 0 � <br />Date of staff site visit: (�. ! 6 / r Initials of site visit staff: Sr' <br />ja/)-1/)S <br />PERMIT APPROVED BY LAND SERVICES OFFICI DATE: 11 <br />UPON APPROVAL: APPLICANT ST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: Page 1 of 4 <br />Laserfische: - Burnett County, W1 Land Use Application — Rev 8/2018 <br />v, ro Cr <br />0 <br />r � <br />° <br />S <br />m <br />o <br />ro <br />0 <br />c <br />y <br />N <br />o h <br />a <br />d <br />io <br />o w <br />d <br />5. <br />n <br />rA <br />d <br />r <br />z p <br />S <br />In <br />Fee Rei �_ <br />Check #:rA <br />02 <br />rA <br />9 <br />UD <br />_ C= <br />