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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> �i Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 •A <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c� 1~ <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 <br /> r i <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. E . <br /> *Items not listed above will be treated as accessory str ures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: 5 �►-� `a„--,,,,,. a. <br /> , <br /> Mailing ( 3() !J / - / cL 6 6 r t /"h t1/ ° r) <br /> AT <br /> PropertyOwner's Address: Q��j` E <br /> 04 <br /> Property Site Address: .t-=-t`'I ,�••—;� � "f S"�'": �7f/c� ca"-cAC4." State Zips- , o c <br /> Contact's Telephone Number: Ca - 3x2—C7f d <br /> d <br /> d 2w\u�� rp <br /> Contact's Email: " �`F 1`�`1�1 V��lti A coE9� . CICU v�-� �ro <br /> Legal Description of Property:Q'�T O'C' R;vers j jloth � � 1 V 00 <br /> ! '! C <br /> Section#: (O Town#: Lid N Range#: l G W Town of: C4M1 lang. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ID <br /> Tax ID#(1-5 digit number;found on tax statement): I 76 N <br /> V <br /> Ej <br /> Proposed Use of Structure/Additiop: Sleet I 64,,A.5 e 7 <br /> Anticipated Start Date: F-,'STk vi. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: , CSN <br /> - <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.J <br /> h yam-- all ' e-f-b4, • <br /> uA- -(zist,o 444 1h�.�, 1 z <br /> gy f �,1 5• g/ 6/'� I m � <br /> Li , <br /> Date of staff site visit: L 0.6( ?..a - Initials of site visit staff: , Z'i Fee Rec: �J <br /> � <br /> p Chark#•5 7 <br /> APPROVED BY LAND SERVICES OFFICIAL: p�� Yr' <br /> / DATE: AVOW ) ; <br /> UPON APPROVAL: APPLICANTIUST POST COPY OF y� 11-1A cp <br /> � <br /> 0. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z:51, 9 as <br /> o <br /> -rC N = m <br /> m.2 <br /> Pagelof5 n � Qm� <br /> Burnett County, WI Land Use Application—Rev 12/2021 < X 0 <br /> v 3 <br />