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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 tcn � <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2, <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 ,� <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n q��, ~�\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 .. O� 101 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o V� <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension Allowed Once) $100 0'''''' k... <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. .1''1� <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: /7�2T 2. 1 5-1..0-4Al ,L, /1061 S�/t) <br /> Property Owner's Mailing Address:?50 ,a,6ti 2, 1/'Cit) c1 /, /V //v d' 5-` 4• n <br /> �Z f-- <br /> City State Zip < &, <br /> Property Site Address: .. ./9 L :=a. o <br /> Contact's Telephone Number: <br /> 4 6Gg_I -74s----'211-07o 7us�.� Iii-s'�� 3 44. <br /> Contact's Email: i '5 �/D�ts 'i GYU 71) ( 9i,/X)1 (1A171 c CD ? <br /> Legal Description of Property: /N41-47t--t --44.. '/ 6 I <br /> Section#: 2c-/ Town#: -313 N Range#: 1 Co W Town of: �C..(�e�ysX , g <br /> o <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 /> Tax ID#(1-5 digit number; found on tax statement): 13E)) ,-3 .-3 <br /> o <br /> ..._ <br /> Proposed Use of Structure/Addition: /7/1///,4 TC '6-.5ZtJ/'-F� <br /> .5, ,, . z: 6 <br /> Anticipated Start Date: S"-/ - Ze,22-- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:SELL- Sewer Installer: <br /> X01 ,--3,--3 3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <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 bunkhouse f.** <br /> Mee4 alt c✓��1�(�J oo <br /> Iri IVotl- c6 14,A~14,A~ k t1 .04 z Fee Rec: *15U <br /> FA Check#: 85 <br /> v <br /> Date of staff site visit: Li/I 2/414Initials of site visit staff: % m <br /> 41 LAPPROVED BY LAND SERVICES OFFICIAL: / / DATE: �J f t�(�pZ r, `, <br /> UPON APPROVAL: APPLICAN' 'MUST POST COPY OF ° C�, <br /> s . r', <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 `" <br /> Pagelof5 t "' <br /> Burnett County, WI Land Use Application—Rev 12/2021 w <br /> t <br />