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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' c N <br /> Permit Types and Fees:(Please,check appropriate boxes): °' <br /> o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 'kl'so <br /> X Accessory Structure(Garage,Shed,etc.) 15 ) Addition/Alteration to Accessory Structure $150 13 \� <br /> Accessory Structure(Commercial/Industrial 200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < po <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r I. <br /> N • <br /> Filling/Grading $150 Boathouse $500 0, 4 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: / 7/iiia /42)Gsi ° a <br /> "0 <br /> e.Property Owner's Mailing Address: / �'7'Y / �//7 P Z 'L l/ _57t)7 k' <br /> �1 ,_, / ,, / City State Zip c <br /> Property Site Address: Z 2-7 If 44 _) N n$o h ��0/ <br /> a <br /> 11 ��c <br /> Contact's Telephone Number: (y/2 --.5- 5--��7f 7 J 'J d <br /> a <br /> Contact's Email: l/f 1,p f'j e i, C c> , l` a - i b .. <br /> Legal Description of Property: 1—€37 7 / C V sc /12/ 5CIO <br /> ' <br /> O. <br /> Section#: 3.5Town#: 3g N Range#: /...5" W Town of: Zein'//r- .. '. <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/o C p <br /> Proposed Use of Structure/Addition: 6.W-- / <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `j *, 'J <br /> Building Contractor: _. 7e//= Sewer Installer: D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I= <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 Po cis <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkho ses.* <br /> 0 eek 0.0 5i%HDGr. s <br /> 0 tV 4- b,r 4,,,,,/► 4 r h" r' r7'I z Fee Rec: �fd�00 <br /> FA Check#:Z.O/6 <br /> Lib ' 1�-2- �- e <br /> Date of staff site visit: Initials of 'to visit staff:, <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: �0 /// DATE: 114e?"?/ <br /> UPON APPROVAL: APPLICANTd .z' UST POST COPY OFle ,F,- "0 <br /> N..3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4. <br /> NO <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> rn <br /> 40 <br /> c4 <br /> a <br /> ; <br />