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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> 71 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure ,"?.)6 $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) \4410" Addition/Alteration to Accessory Structure $150 -0 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 }U r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 /) <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 so <br /> 1 <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. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: Dc-\00/N . eckUJ 3 $ <br /> Property Owner's Mailing Add ess: j ST ! ?lin S cE✓S fi t/ C�5 2 <br /> ,�� 1-� City State Zip o N <br /> Property Site Address: 4' e._Ik,kZi c ?c a%n�✓ tAI .. a <br /> Contact's Telephone Number: (057 —7 3q —8(4` <br /> co <br /> Contact's Email: )(1 Cv • . (t c I-h' 0 11.14-1-1,-,: )r (ow- N b <br /> S °Q <br /> • <br /> Legal Description of Property: L v k \ 00 <br /> d <br /> Section#: It Town#: Ltd N Range#: f/9 W Town of: 5(e14- g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> En <br /> Tax ID#(1-5 digit number;found on tax statement): �1 1 449 , <br /> Proposed Use of Structure/Addition: Cc c 55,; (v•—k.,'t- 5.h,% , 51't . C7 <br /> Anticipated Start Date: (Home/Cabin;Commercial Bdsiness;Bedroom;Deck;etc.) `� .3 <br /> Building Contractor: N d r\t, Sewer Installer: ? <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z --4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Po <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 <br /> home additions,and bunkhouses.** <br /> ghee* 4,1t 5eibc, <br /> rA <br /> rn <br /> CJ <br /> Date of staff site visit: Vig/?.? Initials of sit visit s :ff•• , > Fee Rec:o1 ac� <br /> /4 • C_heckll•4p�/ <br /> APPROVED BY LAND SERVICES OFFICIAL: 7v DATE: OS/2d— < Q <br /> UPON APPROVAL: APPLICANT/ UST POST COPY OF (7 a [iiiii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT H z ^© <br /> fn w f "'1 <br /> ao <br /> Page l of 5 r i K <br /> Burnett County, WI Land Use Application—Rev 12/2021 < g N <br /> C 3 Ifil <br /> T L)3 <br /> z <br />