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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> . Applicant Complete All Sections Below This Line 0 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) d Gl <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C <br /> Commercial/Industrial Structure a�. $300 Addition/Alteration to Commercial/Industrial Structure $200 ��1 0 <br /> Accessory Structure(Garage,Shed,etc.) t50' Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g 0 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350o <br /> Filling/Grading $150 Boathouse $500 c/Dp <br /> Permit Extension(1 Year Extension-Allowed Once) $100 P.• <br /> I <br /> 4 i <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I -, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o _`, <br /> '11VP <br /> Property Owner's Name: £1rerks,4`C Kiri e,44 s Ll-C.. b � 1 <br /> Property Owner's Mailing Address: , , jj i)) I A i ' ole 71 5j'3ff _ `) <br /> (- �.{��[ City State Zip o <br /> Property Site Address: 6✓W 'V, re �A „„ <br /> Fa. <br /> , z r- <br /> Contact's Telephone Number: <br /> 2. <br /> Q S }n <br /> Contact's Email: JOU601 Uhl(f •0,$n N <br /> try <br /> Legal Description of Property: 1,44 <br /> LI C S Pyi s(16/s IAA a,8 IP ,25 7 eC 17LrsJ v <br /> Section#: )3 ___Town#: LP N Range#: )10 W Town of: S Wjss . <br /> 0 <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): 3s9ay <br /> ' b <br /> Proposed Use of Structure/Addition: Ttb) • S u 0 <br /> Anticipated Start Date: ( T (Home abin;Commercial Business;Bedroom;Deck;etc.) W <br /> Building Contractor: /V Sewer Installer: /1/A-- o--1 <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 /> ee- - a 115e 4 <br /> kik <br /> Nof _co( hv✓✓ta 2 A. ,k jit <br /> -���'1 <br /> x <br /> 17 <br /> 1 o <br /> Date of staff site visit: a)If 2-01— Initials of site visit staf,- , IL a Fee Re4)9 ”) <br /> ./ o . <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:ai11��? < QJ <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF a _,., ffil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z n CO <br /> �. <br /> lit! <br /> Pagelof5 m. ; a c4 <br /> Burnett County, WI Land Use Application—Rev 12/2021 < 3`` <br /> ,' Cgill <br /> 1. J, <br /> K <br />