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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> , b <br /> Applicant Complete All Sections Below This Line oCD N <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,V,1 p <br /> Accessory Structure(Garage,She etc.) $1 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 P e I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $150 Boathouse $500 c <br /> Permit Extension(1 Year Extension-Allowed Once) $100 g. <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 /> ql 6. <br /> Property Owner's Name: �. c*,L�CJW —772/-1;e4 b <br /> Property Owner's Mailing Address: 1298 41 si ir� ii' ba _5ycs -�1 E <br /> `7 City -State Zi N <br /> Property Site Address: /.2 qi 1)5.4J.7 pi, ���l,Gz">,)eta / ±-7-1ze61 I <br /> a. <br /> Contact's Telephone Number: "I/`a�--6,,95---,-- 34e/ <br /> CD <br /> Contact's Email: '�yi tI JI) Ice--/, len')d.7')P /77iif[ ,ecv ) b <br /> E. <br /> Legal Description of Property: W , /� E k X. -3c l -' iL s °O <br /> d <br /> 4;1,Section#: , Town#: zip N Range#: ft/ W Town of: C 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> v) <br /> Tax ID#(1-5 digit number;found on tax statement): -7;2 7 <br /> Proposed Use of Structure/Additioq ,()i,6q S�i -,[3 �` . alll' y ��'l l , <br /> 0 <br /> Anticipated Start Date: .)f,1.:54-191 (Home/Cabin;Commercial Business;Be oom;Deck;etc � y * <br /> n C� <br /> Building Contractor: L/( Q b ele GG Sewer Installer: /�dyj "\-- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c) <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 /> 1eZ-4- 4(l 5CA-6,41.6 <br /> ek& <br /> NA- '{ LK n-ai hwb:4"6-c)/) -3 <br /> S <br /> t <br /> Date of staff site visit: 02/4?/ ? Initials of ite vi it staff. )4 m Fee Rec: /5©`' <br /> / // <br /> i v Check#: // !.3 <br /> - <br /> APPROVED BY LAND SERVICES OFFICIAL: i - DATE: 3f 7/2-)-• m <br /> UPON APPROVAL: APPLICANT ST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z a V c T t�7 �l fJ <br /> m 0n <br /> -rC i•m N r <br /> Page 1 of 5 c 0 cc (J t�Jt <br /> Burnett County, WI Land Use Application-Rev 12/2021 < m a r <br /> "o <br />