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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 -- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> . o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 z <br /> ~ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n A <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o i <br /> • <br /> Filling/Grading $150 Boathouse $500 c <br /> Permit Extension(1 Year Extension-Allowed Once) $100 E. <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. <br /> Property Owner's Name: "l3'YL -S - -f4't-<iE t -14,-1 T�"--) a. <br /> Property Owner's Mailing Addressc?79 0( AI/0O/A - L X---7t SSI E- CA) 1 `941-1vi <br /> �, City State Zip Z c y <br /> sp <br /> Property Site Address: r��C._- . F <br /> a \% <br /> Contact's Telephone Number: (4 - 111 <br /> i2---- r1 1 C G.355 d <br /> I <br /> Contact's Email: --t-.l-tom J4-- Derr-el- T` oN IQ- <br /> 5' <br /> Legal Description of Property: w <br /> P <br /> Section#: d8 Town#: Q N Range#: 15- W Town of: Jo-c 11-5t1,01/4-) 3. <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 6f,/ <br /> zy <br /> Proposed Use of Structure/Addition: L C iPt� (s d <br /> Anticipated Start Date: MP,/ ) 0,1-04,1- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `-3 Q1 <br /> Building Contractor:- *v's . NJVA-0QSewer Installer: -- <br /> --r- <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,dwelli g additions,manufact red homes,manufactured <br /> home additions,and bunkhouses.** c9 pt',�t.�- kk f ood eI2Va-4.% ,5 <br /> rhe P.{- a l( 4 S 3.2- b..;, s i Tea /►k�ti,� <br /> 'Nva- ku ✓� 1;;.\-x7C+) n. p - x <br /> 3 L - ;.5 a� 14.5Flo �fl1 (, ' .) sir c tn <br /> Date oo'staff site visit: 3/ i '- Initials of •'te visi staff: I r Fee Rec: <br /> r� ' �� ✓ ill rn Check#: �JC�I j <br /> APPROVED BY LAND SERVICES OFFICIAL: f Ill ATE: �� <br /> UPON APPROVAL: APPLICANT:AVIS JST POST COPY OF r <br /> liVil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - a sp <br /> Page 1of5 ,; 6r -.n- 115 <br /> Burnett County, WI Land Use Application—Rev 12/2021 .3 a Q <br /> Z 0 ; 1 <br /> L. J <br />