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LAND USE PERMIT APPLICATION — Burnett County, WI cr g <br /> Applicant Complete All Sections Below This Line 0' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 I 0 <br /> Commercial/Industrial Structure _$300 Addition/Alteration to Commercial/Industrial Structure $200 N. <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N. g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �--•— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0 <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 I <br /> Property Owner's Name: 10d, Lmue.J <br /> d n <br /> Property Owner's Mailing Address: 1,020 Sou-}, SHon.,,_ ,I�ii_(,,L f OtzcSr (A-Kt MAI S3 v E <br /> City State Zip <br /> Property Site Address: Zg I Z.3 1 <t Avc- D�r�-3,)2y (-Ail SY830 r <br /> a. <br /> Contact's Telephone Number: (n t 2 - s-01- 8-1S-1 o <br /> Contact's Email: —I L4-aSery ?9 e l'Q ar 01"t- /• Cov oN i <br /> Legal Description of Property: Jt-'t()'. I-4,4c Svr.2L 6,'v 4 Yrlo-' 4,f)(4-- L.,r 1, Z <3 KK /I o <br /> d <br /> Section#: 5 15 Town#: L/0 N Range#: I& W Town of: 0/1- AA-0 a <br /> k[.. , <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> --3 -3 <br /> Tax ID#(1-5 digit number;found on tax statement): /'it 8 7- 0 <br /> Proposed Use of Structure/Addition: EA,cloyAl Of .ci& (..-)/(Loup 6,x I'M A,7 7 <br /> Anticipated Start Date: Aral I 11 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: '------- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x v <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to t <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** citt, <br /> reef aLI 54104,4.11, etc-tecS a be:4)1 <br /> S <br /> 2 l <br /> Date of staff site visit: 3/3`/ / 2? Initials of site visit staff: v Fee Rec . b' <br /> / o Check#• _ <br /> APPROVED BY LAND SERVICES OFFICIAL: q1.2 <br /> ' DATE:3l 3l/,-)" • <br /> C3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 's OE <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m N <br /> Iiiit <br /> Page l of 5 , <br /> Burnett County,WI Land Use Application—Rev 12/2021 < 9'2 N �} <br /> om Ur+u <br /> a <br />