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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> • Applicant Complete All Sections Below This Line ' N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ifal ru ure """ Addition/Alteration to Dwelling/Principal Structure $200 <br /> Of Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 }\o <br /> XAccessory Structure(Garage,Shed,etc 5-$17 Addition/Alteration to Accessory Structure $150 �'\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 c, �\ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> t- <br /> 0 )J <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(l Year Extension-Allowed Once) $100 EF 1 <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. 1 (— <br /> *Items <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o r <br /> Property Owner's Name: �:�22L& �� /U'/U 1 I'" "1 f/4tf T� w ` <br /> y , <br /> Property Owner's Mailing Address: /0037 ai.t.„ A IQ 2,i 446„......_. 1) 5-j-z? c <br /> hp <br /> Property Site Address: /35"021 Zy¢2sexl /2a L�/ AIT -GLG4 .�State Zip o <br /> S7 QZ 9 9x19 .� a I• <br /> Contact's Telephone Number: o R <br /> rb <br /> Contact's Email: *1 4,Ve:00 5/--742.44-Edd <br /> CZ. .y e - c!6Vdf o <br /> og <br /> Legal Description of Property: /L L. / Sid Al...:, 04 <br /> 0. <br /> Section#: f' Town#: 39 N Range#: / q W Town of: ST/NMSOL49046 g. <br /> r> <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> � <br /> Tax ID#(1-5 digit number;found on tax statement): p2�J7S''7 <br /> d <br /> Proposed Use of Structure/Addition: S£&-?it£. S VOQ44 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H ( ND <br /> Building Contractor: Sewer Installer: <br /> ib VI <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <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 T <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> •2ee,c- ctiI 4e D, <br /> 6)4(1 r3 c tY be l Calk► � 3 vd-e t— <br /> Gt « — o c a <br /> Date of staff site visit: 2494 � Initials of site visit staff: ,, �L 72 Fee Rec:a'4>— <br /> it v Check#• 4277i <br /> APPROVED BY LAND SERVICES OFFICIAL: �, �/ 2-/ lib- m <br /> / DATE: <' _�J <br /> UPON APPROVAL: APPLICAN '` UST POST COPY OFa ..,, tint] <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co <br /> z c <br /> -<t. a c) a, �_ <br /> Page 1of5 m $= t., <br /> Burnett County,WI Land Use Application–Rev 12/2021 m <br /> ° a ,.. , � <br /> a LJK <br /> m <br />