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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI cr t~ <br /> Applicant Complete All Sections Below This Line 0 cAc. <br /> N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure (Vyly4r $300 Addition/Alteration to Dwelling/Principal Structure $200Er Q3 <br /> mmercial/Industrial Structure ^ $300 Addition/Alteration to Commercial/Industrial Structure $200 \O <br /> Accessory Structure(Garage,Shed,etc, r41. Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 C3 IP <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t r <br /> Filling/Grading $150 Boathouse $500 <br /> a <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. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> / a 1, <br /> Property Owner's Name: 4�n n and Mary .eS a �1 C, <br /> Property Owner's Mailing Address: 1./o?7 3 ,N�lor• Short_ h`,S//'eii�t4 T 5�0 /V—? - <br /> Property Site Address:'?5 V() � /C_KhOi h Rd , , Webs em,�� ty State Zip z o a <br /> Contact's Telephone Number: !/-/)7— 4 76 '-- D3 3 6 v <br /> CD <br /> ,. <br /> Contact's Email: hiec l I('.1'73 r (a bai e Va n'D . et en o <br /> .. <br /> Legal Description of Property: w <br /> C) <br /> Section#:_o al Town#: 19 N Range#: P7 W Town of: L/y7 GO/i'7 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> En <br /> Tax ID#(1-5 digit number;found on tax statement): / 0 7/ti ;"\— -i <br /> Proposed Use of Structure/Addition: S-€cJ 5r)e�5 al T' = <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: Sewer Installer: ,) <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. * <br /> eek a i) Salt.0 NI- 6( <br /> hu g IiPac 'd 71 <br /> ( ?i,„6P rev .,z <br /> p tutee(( Via a600,,t ?WI:. <br /> m <br /> Date of staff site visit: Initials of ite vist" t Si r Fee Rec: 360 <br /> o Check#: ad)-ti <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: 3f7/??- SI <br /> C ' Q <br /> UPON APPROVAL: APPLICAN1 UST POST COPY OF EMI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT0) <br /> f 111111 <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 �; <br /> 0 101111111, 11. I <br />