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A-2,a5 -6.9 l/' e..ckc/t c tc iu v'e <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 0 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 �o <br /> 5 Accessory Structure(Garage,Shed,etc.)Z2 . 50 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 1-. <br /> V <br /> Permit Extension(1 Year Extension-Allowed Once) $100 ° rt <br /> � V1 <br /> NOTE:After-the-fact permits(permit aquired after construction-has Iegun u. �•rim� <br /> *Communication Towers&Signs require a different application form;see correspon sing app ica ion,an, ees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> ° <br /> Property Owner's Name: Cf�i��l C s "1 '3c.,„,,,,,13c.,„,,,,,1►e �4� ' � d <br /> ' &yS S 7 - 014-kat �`/C' �-/ , ° n G <br /> Property Owner's Mailing Address: �� <br /> f rty. State Zip ` < ii b <br /> 7-)e. <br /> Property Site Address: o p� �`tit'1 C/Glia ,,,,s /0 m-^' T ---- . a <br /> /c <br /> Contact's Telephone Number: K r w <br /> WF <br /> Contact's Email: C"' a., ./S`,#J'''t1 K;2,46-1,. C N oo V', <br /> Legal Description of Property: f ~2 (2,...S.1/11 03 14 i`6 P t 6,eD j '4 <br /> Section#: g 2 Town#: LA 1 _N Range#: f (4eyW Town of: til k . <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): 0/ g VN 33 il‘1,1f <br /> Proposed Use of Structure/Addition: C/9 4c.�,r'L/.5 /S ii J ° <br /> Anticipated Start Date:Tr)/,c-- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> t W <br /> Building Contractor: { 1A-- Sewer Installer: "fi <br /> 1 <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 bunkhouses.** S\ <br /> S\ <br /> 0 IA I's, ?U"Mi'f /S Y /744A41 <br /> 7 'tS 147410eA4-• COLIS7414--7`-c40/*jOU/ <br /> ®Ore-yo Use- '69Y A U ren c h 404/7474.4.0/, , x <br /> L� 7 <br /> 'Tate /e caw Q /ssu e_ L� ,iso/a /" o <br /> —Date of staff site visit: 7O � Z . Initials of site visit staff: // /7i[� a Fee Rec: <br /> v Check#: c-0-/.2 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 081/e°22— <rig' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ''' w fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -" Cl) z 0 <br /> tii -- Iffl <br /> Page 1 of m 0 o w o <br /> Burnett County,WI Land Use Application—Rev 12/2021 < "a 4 Q <br /> a <br /> O <br /> 0) Ifil <br /> a a <br /> LTJ <br />