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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> • ro <br /> Applicant Complete All Sections Below This Line 0' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) o. <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 fA <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,..j g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n t" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 X WI State Statute 59.692(1v)Structures $350 o L . <br /> Filling/Grading $150 Boathouse $500 <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 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: 1 e_5. 0 <br /> o4"Prop <br /> Property Owner's Mailing Address: 1 I " l � �� -�� C O �t SW ► s4O . <br /> 4 <br /> �p <br /> Property Site Address: czga C! d 1A`s v & c cU , w.ebC r lN <br /> c_ 'S �e61b(( , ~ • <br /> 4 Will' a <br /> Contact's Telephone Number: 1 15 0 ` \ -).-1 '1 0 ` d <br /> CD <br /> ` <br /> Contact's Email: 9 V Ps\'�"'k..`S e O` co' 1QA \ N ln am' `t16.A Vh 4 , \i co vi. . N <br /> CYCI <br /> 0. <br /> Legal Description of Property: S e fv it A Ac or 1 d <br /> Section#: Town#: N Range#: W Town of: 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> En <br /> Tax ID#(1-5 digit number;found on tax statement): i <br /> Proposed Use of Structure/Addition: \l3 e C,`c, , <br /> Anticipated Start Date:S i'o'\ t,1k (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> ,e,Building Contractor:S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 /> hom additions,and bunkhouses.** <br /> i (Meek- all tom/ 5f <br /> 8Ai - 16 nuta-ho1 ttetotene <br /> in <br /> cn <br /> Date of staff site visit: 3 f 1C�/a-3 Initials o site v' it st: f: , C, Fee Rec: ` 39 7' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / I <br /> O A: Q i <br /> t <br /> UPON APPROVAL: APPLICAN ' MUST POST COPY OF x Ifffil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .iii <br /> Pagelof5 t <br /> Burnett County,WI Land Use Application—Rev 12/20212.1.- ...... <br /> M , RI <br />