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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes) v <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 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 <br /> • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 9 - 0 <br /> Filling/Grading $150 Boathouse $500 N <br /> A, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 ? <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g' <br /> Y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> *210 <br /> Property O �i 's Name. 0 M &d E'. REQ s,= ° <br /> w - <br /> I <br /> 0 <br /> Property Owner's Mailing Address: ., a • - c:9. y . ,. - 0)1. mr. A: E <br /> City State Zip N <br /> Property Site Address: SP filer-- <br /> 4> <br /> 2e <br /> a <br /> Contact's Telephone Number: 7/5— 866, .— g c'5 C <br /> FD <br /> Contact's Email: oN av <br /> 0 <br /> 5' <br /> Legal Description of Property: °Q <br /> v <br /> Section#:0/ Town#: 3`f N Range#: /42 W Town of:'eEc /V 5'. <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Ir <br /> Tax ID#(1-5 digit number;found on tax statement): /0 9"19r i <br /> Proposed Use of Structure/Addition: ,5�2,caf c t7 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^� <br /> CI <br /> Building Contractor: Pf2-r-4.1, Sewer Installer: 'O <br /> -.4:$AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 3 `^Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> P4 <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 /> gitlee,i—4(1 5e1-64c <br /> IVc*- , hw .l b;- '41 <br /> H <br /> v <br /> Date of staff site visit: l 11/ <br /> /212. I Initials of s' e visit taff: ;, /. / _ a Fee Rec: / — <br /> v Check#: 11 <br /> APPROVED BY LAND SERVICES OFFICIAL: ' - , / 'DATE: 3/i i4 (? ?". z <br /> n <br /> UPON APPROVAL: APPLICANT ST POST COPY OFrn <br /> pJ <br /> _) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z i , Cud <br /> Pagelof5 '',.1 <br /> • o gni <br /> Burnett County, WI Land Use Application—Rev 12/2021 ``� <br /> v N <br /> a ig CC <br />