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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) , d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cs <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 10 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 5 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 MP <br /> riveways/&Campground Structures 50$125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 tn Kw <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 1k <br /> *NOTE:After-the-fact ser ' s- is't as uired after construction has begun)may cost up to three times the normal fee. CD II <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r, g. p <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> -71 <br /> Property Owner's Name: 1 Ad ci Yl 61-\ o <br /> b <br /> F. <br /> Property Owner's Mailing Address: 7S416, UMj')da if ,1(1 N ''1c (e oi/e Mili L531 I E <br /> Cit State Zip o <br /> Property Site Address: 27'1 34 p)vie Cone Lane a <br /> Contact's Telephone Number: (320) 293 - 7q 9 o PY <br /> ro <br /> Contact's Email: algd l Qi1\oY d 5U rFes(( V1C.00 WI o rig <br /> Legal Description of Property: p,re CCOC 1 P(CLl ct (cam, Lcs( t7 <br /> Section#: Town#: �F D N Range#: t`7 W Town of: UN L4-, 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): , )0�7 ° <br /> d <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Q1 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> xi <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 /> 0 mak' i2(Lk 5e- e..cilt.G <br /> EA <br /> CA <br /> fv v , <br /> Date of staff site visit: <br /> 3//o 1,2a Initials of site visit staff: y Fee Rec: f�7. <br /> //' <br /> � / 1// ;- <br /> i//�� o Check#: f 9-2I <br /> APPROVED BY LAND SERVICES OFFICIAL: WDATE: 1. <br /> UPON APPROVAL: APPLICANT ' ST POST COPY OF ; <br /> —4,111 N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N 3• <br /> - a <br /> Page 1 of �� rte. EM <br /> Burnett County,WI Land Use Application—Rev 12/2021 0 al a <br />