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LAND USE PERMIT APPLICATION — Burnett County, WI a `° <br /> . <br /> Applicant Complete All Sections Below This Line =c t� <br /> O. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 :a,. .„g <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 , <br /> Accessory Structure(Commercial/Industrial) $200 _Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 up <br /> ,Permit Extension(l Year Extension-Allowed Once) $100 3 <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" . r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> P Y �G "`y c' L;c �L& II <br /> Pro ert Owner's Name: `� ` <br /> DT <br /> Property Owner's Mailing Address: ,O3 SF 9a-r..12.4i..) ��4r i*',`' k) <br /> / City State/ Zip ''''. o <br /> Property Site Address: �i , -,i,L, <br /> 0. <br /> Contact's Telephone Number: X751- div- liiS'7d <br /> 1 ii <br /> Contact's Email: 4 A.LP N_ -. /I1 i L.L.t/L i /-1e)t rvlt ta. _ , Cil i' Z <br /> Legal Description of Property: , . <br /> crp <br /> u. <br /> Section#: Town#: N Range#: W Town of: g. <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): 64ae1412-d— o p <br /> Proposed Use of Structure/Addition: c lu2C L.Q <br /> rrr0 ��� 5 <br /> Anticipated Start Date: 114(/95 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) •' LP <br /> Building Contractor: IV l 4 PAL_►,..„. ,- III <br /> Sewer Installer: M 14 ^ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY LA ' 9j <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.** <br /> 0(hee-c- ctli se-N . _ <br /> aIvy dDf �"4140 la , /J" / -a Fee Rec: (5 0` <br /> 61,1k3 Cllrnta (sr y �Jn y Check#:� � <br /> / o <br /> Date of staff site visit: y I/9(. Initials of site visit staff: r <br /> ` ` a <br /> 7/ cn <br /> APPROVED BY LAND SERVICES OFFICIAL: / / DATE: 460/2-?- x -`�- „�.J <br /> UPON APPROVAL: APPLICAlT MUST POST COPY OFrii iIRO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z w <br /> 4 Nil <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 ^' <br /> rn <br /> a J <br /> i <br /> b <br />