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r <br /> 'LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> �' N N <br /> Applicant Complete All Sections Below This Line 0 n N <br /> Permit Types and Fees:(Please,check appropriate boxes) v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Permit Extension(1 Year Extension-Allowed Once) $100 2 - <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. S' g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> h <br /> g <br /> A <br /> Property Owner's Name: _k_e ( _1--A_Arucf_____- (1____k .--_-- . 0 <br /> ai Z It E <br /> Property Owner's Mailing Address: � S' �� A '' � <br /> ► � S' 'Pik' S E <br /> �_ City State Zip o N <br /> Property Site Address: / a q1 (i <61y, Ro, ,-2Xxl f (� `���1 o <br /> Contact's Telephone Number: —7/S'-�0�5` 3yy Y K <br /> Contact's Email: /4/97,1 An 0 E 1271 1 __.in/4\ n1411_, (c),/Vl N V <br /> Legal Description of Property: k) VA $ E /Lj E x e 3O�i 6 A CEf5 04 <br /> t. <br /> Section#: /a( Town#: &/© N Range#: iq W Town of: ('G' '6. <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): 3,),--7 Co cA w '- <br /> Proposed Use of Structure/Addition: <br /> —546� �/'t C�, Dad fll U <br /> Anticipated Start Date: 5f7 alit l a!71.E (Home/Cabin; mmercial Business;Bedroom;Deck;et c. <br /> Building Contractor:ff-Cita_(, �i I o�.S hie. . Sewer Installer: 17�i f <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z V <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 bunkhouse .** <br /> IV gleth 400 5&034 C, <br /> © "jnj el'G 54-IfkA cAt.ie5 (OD Syfl' or laer need' Mia Use pe/n4-5 ,for <br /> kcceSo ie b, m G� <br /> Date of staff site visit: off/917-a Initials of site vi it staf • . 1.-- (/ (01112.2. a Fee Rec: l 3-6— <br /> v Check#: //---7 <br /> . 0 %� DATE: ?�1 I/?")— : ► <br /> APPROVED BY LAND SERVICES OFFICIAL: � -�, ,„j,_ � � r--1 ( <br /> UPON APPROVAL: APPLICAN .-`MUST POST COPY OF �� <br /> a s -T1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z ccn as.; MIgill.< q <br /> Pagelof5 x �2 <br /> Burnett County,WI Land Use Application—Rev 12/2021 <a,z Q <br /> G grl <br /> 3 <br />