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LAND USE PERMIT APPLICATION—Burnett County, WI g 1 b <br /> Applicant Complete All Sections Below This Line O• FD t� <br /> Permit Types and Fees:(Please,check appropriate boxes) o <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 <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 o N <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 /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. R{{{ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o '1 <br /> F <br /> Property Owner's Name: 7E4./ /7e <br /> Property Owner's Mailing Address: SV SPItie� I//!1 Rb Nfger5 A44/ 55127 ' <br /> T City State Zip o <br /> P ----k , , <br /> roperty Site Address:Z 57 S�Ict �/ffisfl ;,,e %faAJiiOF'y (rJ St/'33() <br /> Contact's Telephone Number: 775--10S.-4113'2 2 <br /> Fi <br /> Contact's Email: /aA/rtgs el'6 I. 0091,L, to (ICI .. <br /> C <br /> 5. <br /> Legal Description of Property:5pt 4t Pito, 446-f, Ler 4 Z6 °4 <br /> Section#: !ti Town#: 11 t) N Range#: f S W Town of: d A C g 5c N 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* IR cA <br /> Tax ID#(1-5 digit number;found on tax statement): S 3 P <br /> jj / d 0 <br /> Proposed Use of Structure/Addition: Q RO� ail Z— S' <br /> .3 <br /> Anticipated Start Date: 4141 /) i . �I}�me ain;Commercial Busines, edroom;Deck;etc.J Q <br /> Building Contractor: Sewer Installer: PY,s+, j – <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z V <br /> ri\f'. r . <br /> OA**The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ,� Ir <br /> Y. 4NY construction.aking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> a I.ome additions,and bunkhouses.** <br /> < , -\)C .Z <br /> f-111ev wf,, Ak 3o f1 SS tai e_ (1.4_c.4t S 4/kw <br /> a *4l`sr c(, €.. <br /> s , fn fl e, s 7 8 74sk . 73i,S suocem , <br /> a t%e eJC/''$7 4 4 74'' <br /> Pmrt:.�n r S �'o t'vt� ® g o u fps, <br /> Date of staff site visit: /f ig 49 a Z Initials of si•=visit staff: P/7/-:. <br /> /711..., a Fee Rec: Q(---)ii <br /> IP o Check#: 1.6 <br /> APPROVED BY LAND SERVICES OFFICIAL: ',miasma, i ATE: 00e02–, <br /> n <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF y �� <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g Nil <br /> cn <br /> Page l of 5 2 3 _ Ci <br /> Burnett County,WI Land Use Application—Rev 12/2021 < :a N Ifilil <br /> m as n cis <br /> o Q o O <br /> Y -0 ~ O <br /> ^-o RD,::e' N <br /> • YYY <br /> I_ <br />