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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 cn N <br /> Permit Types and Fees:(Please,check appropriate boxes) . on <br /> �C Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ..'. 00 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,)J 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 /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' <br /> Filling/Grading $150 Boathouse $500 ,„ <br /> a) p <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* r -"::\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. p <br /> 1.a <br /> Property Owner's Name: /.eacratyt-e- /f-R-yU j' 5/ K A cett <br /> i1--) �— <br /> Property Owner's Mailing Address: it 0 q .-/Qe.tv L, >Ax4.._ 0, 5 if 0 07 . c 0 <br /> �q / n � //' City L� State Zip o , al <br /> Property Site Address: ag©y, /� K.J �'."i' Wi Pa 30 a . <br /> 0. <br /> Contact's Telephone Number: 115- SJC 7 -c3 Y9 d <br /> CD <br /> Contact's Email: 5A,) p Lit,4 / @ � D0 ,_ ,-,_ o - 9' (7 <br /> N 'v <br /> g DescriptionProperty: Jp �Z- P A--c� Va 19 1/ 144. L Y 6Y v <br /> Legal of Pro e ! d <br /> n 1 <br /> Section#: St D Town#: -Ho N Range#: Z. 15 W Town of: ..IG,4 : S. NJ P <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* An c4 <br /> Tax ID#(1-5 digit number;found on tax statement): 6 56 C' ° <br /> P. <br /> Proposed Use of Structure/Additio : kdv'^� <br /> Anticipated Start Date: !?l7 t ZZ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ,-3 .(.-- ...(341 <br /> Building Contractor: ) 4_,L `Mkt" Sewer Installer: �lr.�t+n,4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> Po <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 /> ap !1leek AA 5Cit c c,N.�S �, e2;-/ <br /> v <br /> O.ve(!, tltf�' 6? ekcced 3 b ��ms ()cif()cif5 4 <br /> N <br /> v <br /> CD <br /> Date of staff site visit: 3))5/2'2- Initials of site visi :ff )4 L a Fee Rec a - <br /> /� / Check#: ca-)/Z__ <br /> APPROVED BY LAND SERVICES OFFICIAL: v�J 1 y,,/� A DATE: 3/�a/ ` <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF a <br /> APPLICANT <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 0 r g , 0 <br /> -- i <br /> Page 1 of a vc Cr) C <br /> Burnett County, WI Land Use Application—Rev 12/2021 i a o <br /> m a N <br /> o r <br /> 3 U� <br /> a 3 l� <br /> L1�_1 <br />