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LA1ND U NL YLKIVII I AYYLIUA I10IN —Burnett county, W l <br /> a � b <br /> Applicant Complete All Sections Below This Line a <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) b <br /> Dwelling/Principal Structure I <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 ° <br /> Driveways/&Campground Structures WI State Statute 59.692(1v)Structures $350Filling/Gradin Boathouse $500 <br /> Six Month Camping Unit(One PerYear) Permit Extension(IYear Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9 <br /> z <br /> Property Owner's Name: '-P 0 X QLV1 N1 e— �C7 wNGtS zov, (kril T <br /> Property Owner's Mailing Address: g 8 S \�-cL, ,L$je(»�. LAj�, DR WT I <br /> C t City State Zip <br /> Property Site Address: (�00 O SA �t VC-1 , �OLV-% �11�2 '�`�\j urV, I A3 T- � <br /> Telephone Number:Contact's 0 <br /> �St- z4�- ���y 7! s - s - <br /> 27 <br /> --�'^ d <br /> Contact's Email: CG i^ V 1 C� q <br /> Legal Description of Property:Sww C e-t i3al ES-W'tCS &^ li?>tfr1--,.--T W4 L6-f- 1 <br /> Section Town#: 4 D N Range#:_14 W Town of: SC.o-t <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Cn <br /> Proposed Use of Structure/Addition: Ct— O R'T m i?, 7 1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck, etc.) o C7 <br /> Building Contractor: <br /> ' O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V�1 <br /> r-- RQ_ Ke- �� Cap Q ���- -�S -e <br /> j�-c d✓`� chi � 'n� <br /> x Fee Rec:� <br /> 6�� �� Check#: 3�7 <br /> Date of staff site visi : Initia of site visit staff: r <br /> APPROVED BY LAND SERVICES OFFICIAL. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = w <br /> Transcendent: - Page 1 of 4 g o <br /> :z- coo <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 3 <br />