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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> N <br /> Applicant Complete All Sections Below This Line 0CD N <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \^... <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� 2 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 A <br /> Filling/Grading $150 Boathouse $500 N <br /> Permit 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. g' 1 ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o I. <br /> Property Owner's Name: ( 4U ���e)4Y1 <br /> .-o • <br /> V Io <br /> Property Owner's Mailing Address: &5X •-5---/Y -5i'"c!' CV.r �"Y�?,Z B <br /> City State Zip o <br /> Property Site Address: IC 77 57 , 1,Q c. 7 O n <br /> Contact's Telephone Number: 7/S 2 9' 1,,2 9 S d <br /> 0 <br /> Contact's Email: oN o0 <br /> Legal Description of Property: L 01.; 5-r-r7 V.✓Z P/7 w <br /> 0 <br /> Section#: o• ( Town#:y N Range#: / 7 W Town of: LI /'6'245 a. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): Q f <br /> Proposed Use of Structure/Addition: Rip/�'e-da— � ':3.iS 4.� ,.; / d $ •e—z-,4 0 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .-3Building Contractor: GI"e,z �� Sewer Installer: b J . <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z "- <br /> x <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 /> ) MeP 11 Se-I-b.,I_S / <br /> N ok -co( h.►r►ak Vlw b,: .-hvl) <br /> R2()1ctCl/lc( eA-i - i (h Ph aGi— tne- .c ,4) ,/./4x <br /> cn <br /> Date of staff site visit: a-1 '�?)— Initials o site visit staff: �� o Fee Rec: /5J)4--2 <br /> �I/0/�� v Check#: l541.5APPROVED BY LAND SERVICES OFFICIAL: DATE: < Q <br /> m <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF iIffil <br /> ,-ia <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of :�g t <br /> Burnett County,WI Land Use Application—Rev 12/2021 q4 44 <br />