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. LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 tcn � <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vo <br /> LL) p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ‘;O <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n Lb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - ° d • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �~., o <br /> Filling/Grading $150 Boathouse $500 v) V <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. �' . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: N`a,f.Sh l l a- ud'‘i �``1 ' \ \ 0. <br /> �0 ai 5 ,D, 9-1' f-\u k. 4 Doo\bto y (Ji . '-1 30 <br /> E. <br /> k'Property Owner's Mailing Address: � �' <br /> City State Zip o F <br /> Property Site Address: S arr Z a <br /> C7 <br /> Contact's Telephone Number: 1 l5 (pS(p 2 6 n <br /> Contact's Email: 'YY\(\i\_? S I`c\\ ( 06 viNr , C.p rr"'•- 0 <br /> Legal Description of Property: 4 f /Z- 8//c. 9 n}4/ ,r/Ac/64 / $ <br /> t!uki- Van D u Y c <br /> d <br /> ZS <br /> t <br /> Section#: ZO Town#: y/ N Range#: �(p W Town of: Std/S S 3. <br /> O <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): 2- Z 9/icp / ›o N CO'Teti— ( ct.i, $7a // J 9 t ° <br /> Proposed Use of Structure/Addition: P A /"W1 Q'AN�1 q � qYQ � , ---- <br /> Anticipated Start Date: (HCabin;Commercial Business;Bedrooni�Deck;etc!) `3 \f\ <br /> Building Contractor: Sewer Installer: t \ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z .1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured V` <br /> home additions, and sbunkhouses.** <br /> DtON eir S��ll-e-S /H e-- 041 57YN citiv.e. G.P 4$ q 71vv y et/6y <br /> iz, <br /> vhv 4 W 71'At/S I)e4,0 CQypon /4Gca/, Me- D/1 <br /> le_ — a <br /> eAI SCGtile- /06c7A9d1. 7 <br /> $�y'aGLNI�_o . 7wle_ 5Tco <br /> Date of staff site visit: a/se Z Z Initials of site visit staff: ! / tz <br /> > Fee Rec: l '2 <br /> o Check#: 2'19 <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 2—J /ZO ZZ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF w �,Fi "f� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 3 z C <br /> 31-41.1/e- 0 t' I (/0 i' ) r 026 o ff <br /> Page 1 of 5 ``' <br /> m � = <br /> Burnett County,WI Land Use Application—Rev 12/2021 < 2 <br /> m N <br /> Om <br /> D <br /> 1._____L-___„-.2, <br /> J <br />