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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a I r <br /> b <br /> Applicant Complete All Sections Below This Line c t-i <br /> Permit Types and Fees:(Please,check appropriate boxes) a. J <br /> CV��1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2, . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 03.6x' Accessory Structure(Garage,Shed,etc.)1 S -3.50 7( Addition/Alteration to Accessory Structure 44 4).5 -$493— i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 '' `` C___ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 giv , <br /> Filling/Grading $150 Boathouse $500 v) <br /> Permit Extension(1Year Extension-Allowed Once) $100 z <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. • <br /> • <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i . <br /> _Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. y o <br /> Property Owner's Name: �ar1 4 ce,Q,s °Q. <br /> Property Owner's Mailing Address: (..C)13q. F"i Q C.cTr'1 �/Q, <br /> R. <br /> - m(V 65025 <br /> • City State Zip o y <br /> Property Site Address: 2_$�I DVud c r�dlr' WiLlo Merl J`k(•gg3 - o <br /> Contact's Telephone Numbe Is5I) x,52.• }low <br /> CD <br /> Contact's Email: I j arta. ER co ( Q.O t , C. yy% o z <br /> Legal Description of Property:Oar!Qf { rV Q Vint- 7 L.41-J ' d <br /> N <br /> Section#: Town#: N Range#: W own of: i �SiI'1 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Ce <br /> Tax ID#(1-5 digit number;found on tax statement): , 3 'd <br /> Proposed Use of Structure/ dit' n: PW^1'YIO.ne l.+ _ �o r- . ., 114c 1 d <br /> , <br /> Anticipated Start Date:05 0122, (Home/Cabin;Commercial Business;B om;Deck;etc.) • <br /> Building Contractor: 0 pj- Sewer Installer: t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** <br /> 011ite k—'at( 5C X44 OCArqo tb ,her 41. be remove./ <br /> (;11\)04- -icor Ikt44.4f) 61) 44; 41ao 1) V 618??. -3 <br /> v) <br /> Date of staff site visit: 3/f I?2- Initials of si e vis staff• i % > Fee Rec: <br /> v Check#: 9 l f v <br /> v, <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE:3b•/? a <br /> UPON APPROVAL: APPLICANT UST POST COPY OF �J <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - a . , Uu� <br /> Pagelof5 uom N I1 <br /> Burnett County,WI Land Use Application—Rev 12/2021 0�, cc <br /> . m <br />