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LAND USE PERMIT APPLICATION— Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 (X) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 01 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 •\ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 1\3 IP <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° c <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 N <br /> w <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. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: 4t /\ 0 Ca 0 <br /> Property Owner's Mailing Address: "I,2j2"-/P lA 14'Li c)114 l'i1 v c-b I'1 N = <br /> P ;� ? � f 1v i (ti City Stat Z.-pi , o y <br /> a. <br /> Property Site Address: ,51 )3r- <br /> 3' <br /> Contact's Telephone Number: IDI1 2- 5--0 ' 10(..0. I d <br /> . <br /> Contact's Email: h I n OH e1 vtu , (�,eA (V\ ,1 ' tom N -� � <br /> 0 b0 0 <br /> Legal Description of Property: " ' ')L t a '* °� <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* - <br /> Tax ID#(1-5 digit number;found on tax statement): 2._ Cj <br /> �-d iti ° d <br /> -i 473 <br /> Proposed Use of Structure/Addition: w , ('` <br /> Anticipated Start Date: 5e,,i/(C'11 ciJ y chin:Commercial Business:Bedroom;Deck;;etc.) 4 J <br /> Building Contractor: f Sewer Installer: _' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I� Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I 0 <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.** s'441 a a <br /> tJo-k- e<c e e 8, bec f�/ns G�� ,1-! 3 ; <br /> ao <br /> .fit A rest.* 1 +� ((,1e€i b W al l cS J7(I'� ,, Fee Rec:390 <br /> 94,11' eTct o fce cQ�, el 'S b Amp,' peim.J' y Check#:aI{0 <br /> �3 G✓ le 3 f� f'C i'lo-{- be ;>5,-tri vie 4 e 1 on 'o <br /> Date of taff site visit: /.GJ ,,.--k,,--,,...4- <br /> -, Initials of site visit staff: tJ y~ <br /> �'` ail 5e. 9 / /� E <br /> APPR VED BY LAND SERVICES OFFICIAL:_ DATE:3l��1 a <br /> UPON APPROVAL: APPLICANT cl <br /> JUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Page 1 of 5 rn <br /> 92 <br /> Burnett County,WI Land Use Application-Rev 12/2021 C <br /> w <br /> 11 <br /> 11 <br />