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• <br /> a LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> Applicant Complete All Sections Below This Line oro N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , YJ I <br /> v Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> 4. C; <br /> 'i" Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 T <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 /> 0 rt <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 /> *n <br /> Property Owner's Name: k( e✓'i" L^ .e. e._ 0 <br /> Property Owner's Mailing Address:�66 / /''A r K �-r Do k;ry ti1/4-)-• Se/830 r) <br /> City State Zip c N <br /> Property Site Address: SAeite r <br /> Contact's Telephone Number: /O?— 7i © - 0 7 3 2,_ a <br /> Contact's Email: r'1 e C. gd (a (c4 jf'Lit. /. e 04"-1- N <br /> I <br /> 0 <br /> n 61' ' <br /> U t <br /> Legal Description of Property: Mal< /D.,., ZL-4 Qrt if f keit-... 4;`J t 5,d4 d <br /> Section#: Town#: 0 iv N Range#:ii, W W Town of: p4/4.+t I'll g. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> rn <br /> Tax ID#(1-5 digit number;found on tax statement): / CD(do 9 <br /> Proposed Use of Structure/Addition: /4/('Z ate e 55 ?4 41. k". <br /> Anticipated Start Date: V' <br /> 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -3 <br /> Building Contractor: S t I.F. Sewer Installer: /Lo'&-C._- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z CL <br /> x <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 /> 0 ineeri all Se . <br /> x <br /> n f v <br /> Date of staff site visit: LI) 3 /?- Initials of site visit staff: 11/t/ D Fee Rec: /. 5--49- <br /> aiii o Check#: 9('�/` <br /> APPROVED BY LAND SERVICES OFFICIAL: fiCA. �/ i DATE: L/'3h73 w <br /> %� POST COPYOF y � - �� <br /> UPON APPROVAL: APPLICANT MUST E <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z g 3 23. c <br /> r 2 = w twin <br /> (7 <br /> Page 1 of 5 x p. es = <br /> Burnett County,WI Land Use Application—Rev 12/2021 <br /> v m ff <br /> cn 3 , r <br /> V <br />