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f C4 '171 <br /> V— ' LAND USE PERMIT APPLICATION - Burnett County, WI `° <br /> N N N <br /> Applicant Complete All Sections Below This Line 0 a N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> ,� o <br /> Accessory Structure(Garage,Shed,ett X50" Addition/Alteration to Accessory Structure $150 -.1 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 U <br /> Filling/Grading $150 Boathouse $500w % <br /> Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. 7 <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. o <br /> *11 0116 <br /> J / <br /> Property Owner's Name: 7,64,', i7,64,', ��' / A../l� et ---7-;, <br /> %/c ,x-, •o <br /> 17.' 7C ? - ;2 - /,�(/� ) Sc ' k <br /> Property Owner's Mailing Address: <br /> City State Zip ' o — G <br /> Property Site Address: ( 2 ( 4/ A f S 1,� ,i'Z�'� lit, 'T/,c /-r E <br /> I7 <br /> Contact's Telephone Number: CD <br /> d <br /> Contact's Email: l�)//,/- 7l_.3 e7(?/ /�-..�'C ) • <<, n <br /> Legal Description of Property: /I^(y/"� l501 W LI �( V 63 7 9 I _ d <br /> Section#: 9'2- Town#: 3 ( N Range#: I b W Town of: /�S f �� r < .�c�� I <br /> *Attach additional page if needed for lengthy description OR attach a copy o the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3 5 0 3 ° <br /> i C7 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -3 <br /> Building Contractor: Sewer Installer: <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z W <br /> z CP**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.**FINf <br /> mee'' CU 5e lit <br /> a � <br /> 7 <br /> Date of staff site visit:3/6 /?-,?�� Initials of s'te visit)!ff: I m Fee Rec: <br /> v Check#: <br /> . - / m <br /> APPROVED BY LAND SERVICES OFFICIAL: p -,/.--% /If DATE:3 /?a c r <br /> UPON APPROVAL: APPLICANT UST POST COPY OF �`-�' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0 70 rs <br /> Page l of 5 v o -0- <br /> Burnett <br /> Burnett County, WI Land Use Application—Rev 12/2021 < m <br /> i7 a'< N r <br /> a m uu <br /> 3 Lam....: <br />