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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line 6' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Ts <br /> Dwelling/Principal Structure I$300 Addition/Alteration to Dwelling/Principal Structure $200 g. ` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 6.1)S<‘ tairs/Patio/Retaining Wall/Sidewalk _Bunkhouse $250 0 1'- - <br /> y) Driveways/&Campground Structures $125 WI State Statute 59.692(1y)Structures $350 o u r <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> P-.. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. b <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> I/INN-AA Property Owner's Name: --y), ���', � ii <br /> Property Owner's MailingAddress: <br /> J a I c \\I ) l3 l', Lit r^ n ,* <br /> (Do Cityr -1 State Zip IMP' � i <br /> Property Site Address: qp l hsev) L tri" W <br /> Contact's Telephone Number: \A1_.2 '� p/ --..'Y <br /> Contact's Email: y j � � 3 b 3 [ ,Oz N o0 <br /> Legal Description of Property: t � �) VD t 21S I t t—��5 sic d <br /> Section#: 1 a-- Town#: N Range#: W Town of: 1---1()6C:017) _ a <br /> *Attach additional page if needed,for lengthy description OR attach a copyofe deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): .32- 1-)1 c4 o x <br /> \ 6. <br /> Proposed Use of Structure/Addition: -- CA) y E-- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: (� <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <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 /> �'V1 ee-L- C4 1 t 5e-f 6acJ(5 // <br /> Pt:y Yet 1, per".- 1I f?? x <br /> Date of staff site visit I/a/a-2.- Initials of sit visit staff: o Fee Rec: 4251"- <br /> i�� o Check#: '/(>1377 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ) J3J122- r--I <br /> UPON APPROVAL: APPLICANTMUST POST COPY OFco <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • <br /> aD <br /> W 0 <br /> - w <br /> gifil <br /> Page 1of5 ' g2 o <br /> Burnett County, WI Land Use Application—Rev 12/2021 S.< Q <br /> 11Ji <br />