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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> N N <br /> Applicant Complete All Sections Below This Line aN <br /> CD Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,w"`� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 XAddition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,r4 <br /> -- i <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 /> v <br /> Permit Extension(1 Year Extension-Allowed Once) $100 = <br /> ',.7 Z <br /> *NOTE:After-the-fact permits(permit aqui red 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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. p <br /> Property Owner's Name: /NpoK{{ bNEL5oi{/ <br /> F.' <br /> Mailing 610 gray y C� k /Aw, Sr.egarx 61.5 kir 5* ° i <br /> PropertyOwner's Address: / � <br /> �UJ '/ ba-vg City ��/ State Zip o N <br /> Property Site Address: 3 3 72 bdfEr/t/ � i�5rF�� W-r 0 <br /> Contact's Telephone Number: (Sf-2 L/7` M97 <br /> F <br /> Contact's Email: P11df140 65 &/yak oo,Gomel o trq <br /> o <br /> Legal Description of Property: iC/-) Too / ! /pl.( col 11/5-5-5� `r 7 P 1f0 04 <br /> o u. <br /> Section#: I I Town#: qo N Range#: ill W Town of: 5C-Q' " <br /> *Attach additional page if needed for lengthy description OR attach acopy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): le <br /> 2 2 g� H0 T H X <br /> Proposed Use of Structure/ dion: <br /> �a ,4e a, <br /> rctdCI ft 7n ° a <br /> _.3Anticipated Start Date: is- 22... <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '---- <br /> Building <br /> Building Contractor: se If Sewer Installer: /v/i4 <br /> 7cat)v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z <br /> totort their UDCJ rectorto oto �'K <br /> **The applicant needs con_.._. he.. _nsr__�.,. d.,...rmina i� Ncr;nit is:.ceded f,•-oat dant prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> IIPMee ck,\ 540 • <br /> a - �r k,a.414.i .d-r- x <br /> 7 <br /> = a <br /> Date of staff site visit:3 I t O/2'2- Initials o site vi 't s : : H a Fee Rec: <br /> � // o Check#: /zi(4 <br /> APPROVED BY LAND SERVICES OFFICIAL: w / /. �' DATE: ,3(l'!2-?- < <br /> CD 1-1 <br /> UPON APPROVAL: APPLICANT UST POST COPY OF rn sw <br /> t. <br /> m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTfix` <br /> r < 3 <br /> n <br /> Page 1 of 5 po t c� <br /> v. <br /> Burnett County,WI Land Use Application—Rev 12/2021 < , a I <br /> 0 IAC N01 <br /> N <br /> H cp ,r"; <br />