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• <br /> LAND USE PERMIT APPLICATION -Burnett County, WI b <br /> c <br /> a <br /> Applicant Complete All Sections Below This Line 5' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c) b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 b <br /> Filling/Grading $150 Boathouse $500 C4 1. <br /> m <br /> Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> - i <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 0 <br /> o <br /> Property Owner's Name: ScolfzU <br /> 3 _ 4Pro a Owner's Mailing Address: LI9A 5 Ave, S t�n�U��tS �",/{fV ��lj9 4 <br /> , City State Zip < <br /> Property Site Address: ( )"t <br /> l KPS NY Rd <br /> Contact's Telephone Number: q/�-"l�17-ai."30. <br /> o <br /> ro <br /> Contact's Email: Sivl�l4I w5c,e rai l .tail c <br /> ' <br /> o <br /> Legal Description of Property: NV N(n/ FX k‘) 33?fd <br /> Section#: 36 Town#: 4 f N Range#: )6 W Town of: 3L1?55 3. <br /> e) <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 ! 1 'A a <br /> Proposed Use of Structure/Addition: 5 • • c lied \''') - d <br /> Anticipated Start Date: 2 ,AA `` 't a- • 1 ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) NI <br /> Building Contractor: t'VhSewer Installer: ! 4J <br /> V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY --A <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 /> Mei- Cal <br /> Nva{ hw r 1 h4bt; rb • <br /> Need c t/ �' plr/K''�"` i•C- cAiv )i ✓ mC�e — 14nyeeioikl a'�"''"`"' �T'' g C�r,.l :vim . . CA <br /> ° —cam <br /> Date of staff site visit:379 4'a Initials of site visit staff. i t� r Fee Rec: r <br /> a <br /> , V o Check#: /9 <br /> APPROVED BY LAND SERVICES OFFICIAL: Citr DATE: 3/?- ?".)-4lcACD <br /> UPON APPROVAL: APPLICAN -MUST POST COPY OF ig <br /> rITN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -)co 0 <br /> la co INO <br /> Page l of 5v g o <br /> Burnett County, WI Land Use Application—Rev 12/2021 0 B. 2 Q <br />