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LAND USE PERMIT APPLICATION — Burnett County, WI c b <br /> Applicant Complete All Sections Below This Line ;' E c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a 1 W <br /> Dwell in Princi al Structure 1 e <br /> g/ p $300 Addition/Alteration to Dwelling/Principal Structure $200 L <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure 5200 ' to o <br /> tea) _) Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 U\ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> s <br /> *NOTE:After-the-fact permits(permit aqui red 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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. j o <br /> i0Pro e mOwner's Name: �v.p �w, `x- .a�vr�� G .w �a <br /> 2 <br /> ° <br /> 'OPro e 'Owner's MailingAddress: 3o) l 6 Q�.r,ca._1' YAnK � 'T Le-Sr So © <br /> City State Zip e <br /> Property Site Address: -S q0-. — c- A-tZb„€e •° <br /> Contact's Telephone Number: a t .. 3� 3sco <br /> _ � o <br /> Is <br /> Contact's Email: -➢moi,,,,,o s era)� v.a.k4.-_ �v vie. o w'0 <br /> 8 <br /> 5' <br /> Legal Description of Property: -r-44,..r ?► T .Q+:-t.,,.- K -5 .3 t_,TIe.a5 n►r_,.r c,. 4.E,,,. '- ,2,, r� °O I 1 <br /> Section#: 1% Town#: geo_N Range#: I� W Town of: er���c�...� -,-___ c' a <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 3 9-49 37-) o <br /> Proposed Use of Structure/Addition: SNE cD u 4=a0 "Sivitp ( J <br /> Anticipated Start Date: t I i I:�\ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �Al <br /> 1 V v <br /> Building Contractor: .sE�,c. Sewer Installer: N-1J A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 3. — - <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z (L I' <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 /> 66 /Y1ee-A- ex,I I e-f-baGtt,5 <br /> Date of staff site visit: /1 i 2 Initials of site visit st L rFee Rec:3W <br /> j -/ 6, Check#: 934 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ?/1547)-0) S <br /> UPON APPROVAL: APPLICANT UST POST COPY OF yJ <br /> Ell <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 11, <br /> w e m <br /> ffil <br /> Pagelof5 to <br /> v <br /> Burnett County,WI Land Use Application—Rev 12/2021 d ` <br /> 3 N Q <br />