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• . r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 N <br /> cs <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> ` <br /> 1/� f <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 $250til <br /> Driveways/&Campground Structures _ $125 WI State Statute 59.692(1v)Structures $350 0 �j <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. i .. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: '16"y K1 0a <br /> Property Owner's Mailing Address: c 7a "vi 111 t(J pi, ed4,te /;14,/ c 53))- <br /> / ty Staff Zip <br /> Property Site Address:"/7C- ay G4 ki D /1� b�� S C r b 11l <br /> ) / <br /> - e 1 v <br /> 0. <br /> Contact's Telephone Number: l,� D 3 <br /> g <br /> G <br /> QCD <br /> Contact's Email. fd/r / yr 0 /) U i",, ) N a <br /> �f. <br /> Legal Descrip ' n of Property: 'V C� fr 6 l . U 6:i 1-0 &cb ..<13/ J 3 7 d <br /> Section#: I Town#: 1 N Range#: / lJ W Town of: "J2(-'!1 67'1 g. <br /> *Attach additional page if needed for lengthy description OR attach�a copy of the deed OR attach tax system property page.* <br /> 7-1 <br /> Tax ID#(1-5 digit number;found on tax statement): i/fJ N F <br /> \--"." . e <br /> p � <br /> Proposed Use of Structur / dd' ion: a Ca 3t--7 v <br /> Anticipated Start Date: S Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -+ <br /> C z r 6-trIs1f v C t Sewer Installer: <br /> Building Contractor: eej <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <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 /> ho additions, and bunkhouses ** <br /> /• Meek- ati Se JS' ,it <br /> e No-I- {or Ling) - ') .j <br /> Q ke oh lt'I �,{•c R� ✓lei, rnee-� Rr1 rJk�- o-C.-tom' seeks.y <br /> 31-a- 12- 2-2-' Initials of 'te visit staff: . i Fee Rec:/ <br /> 0 to <br /> Date of staff site visit: / <br /> / v Check#: (I(il-) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/0n! P-�- A <br /> �i.� <br /> n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 11 ''..° © <br /> Page 1of5 - o �, c <br /> Burnett County,WI Land Use Application-Rev 12/2021 2 Q <br />