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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line o• c N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> o V'+. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 - <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.)21,5 -$4-59 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 <<_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 V, ? • <br /> Filling/Grading $150 Boathouse $500 cn <br /> Permit Extension(1 Year Extension-Allowed Once) $100 = <br /> . 0 <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. r9. —C. <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 77) <br /> -� ` - r� <br /> Property Owner's Name: ' 1,/H2`�'Y1y ,L VVI I 3 a I r - <br /> }} 1 n C_ + �'tb' 1 r v, <br /> Property Owner's Mailing Address: c)C 3 / -�G'C.'L � �J�f A. kr` UJ1J 4.;; E <br /> c ` ' (� City State Zip c h <br /> Property Site Address: 3 ) Se ,L�� il`c'J�-r . , CD V. <br /> Contact's Telephone Number: 715- b 5 6- 3' r--• v <br /> Fo <br /> Contact's Email: 4-% Au - r\L a\ 19 t,e 904,I . c p' '`^ N <br /> ael <br /> Legal Description of Property: 5 1/2_. SE MA) tl° <br /> P.. <br /> Section#: ).0 Town#: q l) N Range#: 1 7 W Town of: Od•.Lr\ . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number;found on tax statement): 1 _ x <br /> Proposed Use of Structure/Addition: 51 cr'''-c.7k C 61-,..-7\--, L�.r, -Ir-v-fo, /.14,0 ltt+ 1 d <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> -33 <br /> Building Contractor: inakt, 60,-vnt2••': kCe- Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYVv <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z ii) ' <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,�tand bunkhouses.**� <br /> Omer Ail -ba of CI Yvo# haw] 1%46,404104. / <br /> d A l! Skrucwrts + 6011e,room* S r oar' loo),-C-1— /lea) ()W '5(* tiG <br /> 0 w4' rtee� CuPor be. rem✓ 6/it)?. 6/II?2.P ) c <br /> rr <br /> Date of staff site visit: 3)1/?? Initials o site vis't st ': o Fee Re ?)J�- <br /> / 6 Check#:2,,2 7( <br /> / m <br /> APPROVED BY LAND SERVICES OFFICIAL: .f �, DATE: 3/�/aa- o <br /> n t <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF a Fo ter CN ff <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z T T 4 a N UP • <br /> Pagelof5 m oo o �" �c <br /> Burnett County,WI Land Use Application—Rev 12/2021 < w K N C <br /> o a tU <br /> 0 m <br /> i <br /> ro <br />