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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 c N <br /> Permit Types and Fees:(Please,check appropriate boxes) ° �a <br /> d '1 <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 F �y <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V.i o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 . g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 9,,j <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 E <br /> Filling/Grading $150 Boathouse $500 cn <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. g 1. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> M S ft <br /> Q <br /> Property Owner's Name: �c�c-bara / o€ MN o. <br /> g <br /> Property Owner's Mailing Address: i(�2 15 REGE-►JT Ave No Boo'cot I.) P K�v� ' <br /> City State Zip < <br /> Property Site Address: '228/05 OLD 35 D4-1.2 t E(.5, tut 9-1S7-2- g <br /> Contact's Telephone Number: (012 - 41q3.1.6,Lf•3 3 d <br /> Contact's Email: SA e?n e r k rc„u See a. Go rvt N <br /> Legal Description of Property: "fM irr PRT N 1 12 Su) S L) Ly 614 Oh Ti NJR€ A. <br /> d <br /> Section#: 2.I- Town#: AB N Range#: R I-i- W Town of: 1)Pd.) 1 el,St g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property pdge...t__ <br /> r-› - <br /> Tax ID#(1-5 digit number;found on tax statement): ..2.10 2 3 <br /> Proposed Use of Structure/Ad ition: PC!RC f-i es 2 d <br /> Anticipated Start Date: S I, / 2.4)-2.,.2..... (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `i tJ <br /> Building Contractor: Sewer Installer: ft/ /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.* `S <br /> IilGe.4-- All 4.0 s <br /> pot fpr Lew 14,-t O/7 a <br /> 7 <br /> y <br /> Date of staff site visit: 69/?,14/2. 2 Initials of ite vis' taff: - KI- o Fee Rec: / <br /> o <br /> Check 3L <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/ f/a 2 _ rn <br /> UPON APPROVAL: APPLICANT UST POST COPY OF <br /> r in1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z Co <br /> A ll0� <br /> Pagelof5 Comi; Co <br /> =Burnett County, WI Land Use Application—Rev 12/2021 .g V <br /> 0 owe <br />