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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5� N <br /> Permit Types and Fees:(Please,check appropriate boxes) a d <br /> FF} k)s <br /> Dwelling/Principal Structure $300 K Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 .J SL% <br /> Filling/Grading $150 Boathouse $500 cn I% <br /> P <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 po <br /> Property Owner's Name: -e Lelre� �`i •' S C A 0 k� o <br /> Property Owner's Mailing Address: ' `]�- I o �/2A rn Ilii l h j,,.� (d'• &,141rbvl i w <br /> City State Zip o <br /> Property Site Address: 5'."41e c—V 40 a <br /> Contact's Telephone Number: 651- L/9.2` q 9 @ nay d <br /> Contact's Email: 3 5 C 11 VII i i 0 S} <br /> Irl 414 Jcp 6 0k_{. L 0 V N pc <br /> o <br /> s. <br /> Legal Description of Property: Nis S b3 S 3*- 1'3 0/kJ— R I ( /4}� i o <br /> Section#: l 'T Town#: 3 -! N Range#: ( -1 W Town of: Gies/ (/'7A I,-el) IICivt de <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o m <br /> Tax ID#(1-5 digit number; found on tax statement): a (� H I 4^ x <br /> Proposed Use of Structure/addition: K i'-+-6 L1 tk. I 1111119 , oe I N,h j , betkoe1.4.0/bm/Al ,20 ill.,- <br /> Anticipated Start Date: A cop (Home/Cab�j,;Commercial Business;Bedroom;Deck;etc.) 414 <br /> ^ <br /> Building Contractor: 13MvIM A v' aieistrockg 0 n Sewer Installer: i^l/ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY t `-� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their LDC Inspector to determine if a permit is needed from them prior to ‘ <br /> ANY construction taking place for an;'dwellings,dwelling additions,manufactured homes,manufactured <br /> home dditions,and bunkhous s.**I t <br /> Ole e4- a� �I cUS ,I, C/�N-1 q- LI 1 yy4040. <br /> tli Y1r7f' 4o �' a ✓OD 5 �r x Fee Reefb L70 <br /> Check#: / <br /> c, <br /> Date of staff site visit: yDI laa Initials o,site v t s�` a <br /> 1 /,/ <br /> n- <br /> c) <br /> APPROVED BY LAND SERVICES OFFICIAL: min- - Hyl /yr- DATE: W??1aa g] Wlia <br /> frnn gl ai <br /> UPON APPROVAL: APPLICAN C UST POST COPY OF <br /> il <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo U <br /> .,G li <br /> .:(R. N V <br /> Page 1 of 5 ^' <br /> riq <br /> Burnett County, WI Land Use Application—Rev 12/2021 < a <br /> o <br /> cn <br /> a <br />