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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line = A N <br /> Permit Types and Fees:(Please,check appropriate boxes) G- <br /> 'x Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 j E. <br /> 11 __ Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V <br /> 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i 0 <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 <br /> Filling/Grading $150 Boathouse $500 <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 3 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o In <br /> T. I1 n <br /> Property Osrner s Name: 6�l (4 F, t >R,£ r C C./�- .S, G l„s C .H T r <br /> Property Owners Mailing Address: /0 0 /3 5 I'r• Pig*/xl /1, G/5541 1y <br /> City State Zip < r <br /> Property Site Address:/ Q Fr 9/ S PI k I r I"A6 /Q U• &, nt/�S 3 ff�& t,(,► i . 1 c , <br /> Contact's Telephone Number: 3 0 5 6 .5 2 0 -• 3 b e/ �/ G yQ <br /> Contacts Email: Qi aL i.,-, a e ' I ./ . , ,, i <br /> .i...v <br /> Legal Description of Property:S C? € 0 4 ryj 2, 7 A3 i g ( t) 41 6 2. or ti ' n) "o J <br /> Section#: (' i Town#: 3 2 N Range#: / a^ W Town of: 7."4/1-DF j_ 0/,'6.. <br /> *Attach additional page if needed for lengthy description OR attach a copy o/the deed OR attach tau system property page.* I <br /> r <br /> g 3 � 1s O p <br /> Tax ID#(1 5 digit number: found on tax statement): 74 73 <br /> Proposed Use of Structure/Addition: /11 0 ("3 / C - 1+ O J�, aZ t 1' W 1_. <br /> Anticipated Start Date:-� P 44 /I/(r " ..CI k.A. (Home Cabin:Commercial lumina �eeax ii4i4es.i:etc.) ,\ <br /> Building Contractor: Sewer Installer:IN DFS Ru&` .S ti-- ' L ''ti ti <br /> % tAREA 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 i <br /> ' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured <br /> ! t <br /> ho i ditions,and bunkhou es.* / <br /> • ae 44 <br /> - . p,^,G&I t' -69 eneett 3 .1),(ftDeins <br /> 7 <br /> Date of staff site visit: ✓/ 6/.2,-) _ Initials of lite yip sty/ y Fee Rec: -t-1))` <br /> // /o�� c Check#: 3(21> <br /> APPROVED BY LAND SERVICES OFFICIAL:_ / DATE: 3/ 1 _ J <br /> UPON APPROVAL: APPLICANT ST POST COPY OF ° ; [Mf1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o c CO <br /> Page 1 of 5 x me <br /> S g4 <br /> Burnett County, WI Land Use Application—Rev 12/2021 . ' KL __]YAH <br /> ti � L — J <br />