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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) d 0-1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure 00 Addition/Alteration to Commercial/Industrial Structure $200 �W p <br /> Accessory Structure(Garage,Shed, c.#?�j Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Indus is $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 L. <br /> Filling/Grading $150 Boathouse $500 v) , <br /> w <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> - <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' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ^ <br /> Property Owner's Name: Al/4 1Q\j �A A. e L% 1..- 1.-- 0 <br /> a410D � t� 1, s . , h . iI .b V. 6) $3 °F. E <br /> Property Owner's Mailing Address: �yi, h r j �� � � E <br /> City / State Zip c N <br /> Property Site Address: 54-l1j 2 <br /> Contact's Telephone Number: 412/M ' 4 g g - 77 3.---c7 . <br /> ii <br /> ,,r --11 1 <br /> Contact's Email: /t'b r-7-1-, tub DG;t S Rq zz 1 r° c. 3 h"i 4..` • d-d Yvt °q <br /> ' <br /> � <br /> E <br /> Legal Description of Property: (—ok 1 (Jr 3'>O1 V Ile. f t4 c`-4' SOD($ 0. <br /> a <br /> Section#: 1 Town#: —I 0 N Range#: I LI W Town of: Scott a. <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 /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): / 9 j) g ''7:' o <br /> Proposed Use of Structure/Addition: C>(Tp..kf j al, <br /> � 2 54 r, es <br /> Anticipated Start Date: d (Home/Cabin; <br /> ,e—id <br /> Business;Bedroom;Deck;etc.) H <br /> . <br /> Building Contractor: — e !.. Sewer Installer: IL <br /> Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zUJ <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 /> 010,f'1ee-r- all Sect ° �1�� <br /> , <br /> No A- 6( waa 6,itkAgtl-A+PilN ( T) <br /> Date of staff site visit: -511 I).?.- Initials of le vis' staff: j to <br /> > Fee Rec: aa� - <br /> _ o Check#: 14 I OS <br /> APPROVED BY LAND SERVICES OFFICIAL: i / DATE: 3111?)- <br /> 75 lUPON APPROVAL: APPLICANT MUST POST COPY OF Qiii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z a gr...1g <br /> id <br /> 7 n <br /> Page l of 5 M me, c tC <br /> Burnett County,WI Land Use Application—Rev 12/2021 3` v urtgli <br />