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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a g r <br /> EA <br /> ' Applicant Complete All Sections Below This Line 0' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a.� - <br /> P <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 r- O <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 - c <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,-o <br /> / <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° `/ <br /> Driveways/&Campground Structures _$125.... State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150' Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. R. i , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> o <br /> Property Owner's Name: 1". (13r c C1\\ C5�0 dA c ,• <br /> Oh <br /> Property Owner's Mailing Address: 3 7 6 i Loc Lk R cc t` tato qtr'.f ' S' RSO ° E <br /> City State Zip < <br /> Property Site Address: 4--t'on I-e-1L. 124-- °' g <br /> Q. <br /> Contact's Telephone Number: l t$ ase, 3 17 7 d <br /> Contact's Email: oN oV <br /> Legal Description of Property: FR.L tJ to '/4-/ j,� L �>'b 1—troy, &wit_ Fi a.,) ,e, <- fx ad <br /> Section#: SO i Town#: 11-10 N Range#: R is" W Town of: J c,C.k SLh 3. <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): q 3 Li c4 o <br /> Proposed Use of Structure/Addition: cetrg 1 e_ 1-) v <br /> Anticipated Start Date: Myr (5t (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' <br /> Building Contractor: San"-ke.--' gO r' t'qe y' 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 i ) <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to i <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** <br /> 0 -Alee - a It 5 ckb , �,� <br /> N �� <br /> Lo\- neeJ e ddl rem v SR R l?? z <br /> J / Initials of site visit staff: 14 La Fee Rec: l�� U� <br /> Date of staff site visit: "! h�(�'� <br /> 0A15-I— <br /> z (harL+F — <br /> LI <br /> ��� <br /> APPROVED BY LAND SERVICES OFFICIAL: 4 DATE: 1'1,3b#1 Q:%F, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ..:. _ <br /> Page l of 5 NI:" <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> W-, <br /> a <br /> 4 4 <br />