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LAND USE PERMIT APPLICATION—Burnett County, WI a c <br /> b <br /> Applicant Complete All Sections Below This Line t.ei <br /> (D I <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> ✓ 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 O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i ti 3 <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 a C <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. o P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 6. <br /> Property Owner's Name: Ti y►1 1/1 U'o(iK <br /> LS <br /> Property Owner's Mailing Address: go,/ 2.91 I k L. C 4-rte--l' O S c eo\it WS- SL1Q2 0 i <br /> v, <br /> L� 1 I City State Zip C y <br /> Property Site Address: 13 0Q 8// T L Li vt e r�,r c! 19,",t 0 a k b u yr uUJ <br /> cD <br /> Contact's Telephone Number: S I- 3 SH -1 t t g / <br /> C d <br /> Contact's Email: Ve e b o e le C-i-r 1 C e 514,,4 (./CO kin N -o <br /> V <br /> Legal Description of Property: vy 4.5 t v V• t I k t�,t, [�o } 34 a�, 3 3 <br /> d <br /> Section#: Town 4: N Range#: W Town of: i G( k SOY) E <br /> o <br /> *Attach additional page if needed for lengthy description OR attachtt/ a copy of the deed OR attach tax system property page.* <br /> H H <br /> Tax ID#(1-5 digit number;found on tax statement): O 1p 14 66 A S C, <br /> o <br /> C ; <br /> Proposed Use of Structure/Addition: l- a h <br /> Anticipated Start Date: Ar 1 20 2 Z. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H L- <br /> Building Contractor: Av't]f vt C a ks, rii t-f a tel Sewer Installer: (� , w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> xi <br /> Mee.-}- 40 sel-bacit-S 40 r 1)hl 0 -,,Ae. 'op :4--Ai <br /> No+ kms.mew ha►br� ""e`4" 4' 410,11 PSP' ` <br /> 14 <br /> iJ4 e. <br /> 3 Irn 1454- be CoM b, e ( Vi4 Cergeg 5(4� 141. CcsM) 710)-,2 Ce <br /> Date of staff site visit:A 112? Initials f sit/visit 'ii/ D /5-7)Fee Rec: � <br /> / g Check#: 39E:19 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:?� /�a z ) [� ' <br /> UPON APPROVAL: APPLICA fig �) <br /> MUST POST COPY OF <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT as m <br /> W 0 <br /> Page 1 of 5 .c- <br /> Burnett County, WI Land Use Application—Rev 12/2021 o <br /> c <br /> Ril <br />