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' r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 tco � <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '- - p <br /> it <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150co <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> C_-_ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < A <br /> tDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 0 <br /> Filling/Grading $150 Boathouse $500 c t <br /> w <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> . .1,` <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. I. IP <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> r <br /> o <br /> Property Owner's Name: J ah.t.e.s 0 4 M(Lay / V O h, e1 4 7—/?4,5T 0 <br /> I 5' n C <br /> Property Owner's Mailing Address: /c{ Co P/ Hyde. 1--/4✓G. N45 O ti/(/ ...5-5-63g <br /> City State Zip < — ii <br /> Pco <br /> roperty Site Address: 3 7 6 3 o ON q/1-'1'-c_ /?ol ,�//arVhufT� T. 5-448 3 o <br /> Contact's Telephone Number: 6 57 '1` ? 3 3 5 v- d R Ca st' a O g 9 $4/ o <br /> Contact's Email: y o ll e/q g N e-F-2 e I?o , C 0 PI N b <br /> 1 0 w <br /> Tirk <br /> Legal Description of Property: 1— m T 3 C S MV / f l is 5 N i <br /> CM v) °. <br /> 0. <br /> Section#: ,S O l Town#:T*1/l/N Range#:/'i / 6.- W Town of:(O/4 TO A)/y c( J 4rrsoy <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): 47 Li' 5- i <br /> Proposed Use of Structure/Addition: 5 t cJ e to A//t - <br /> Anticipated Start Date:rih-f' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> Building Contractor: J�L__ Sewer Installer: t ....P <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ) (J\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> x <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 bunkhou es.**( <br /> O/YI ee4- AM 4GVtS <br /> x <br /> Date of staff site visit: 111d`6(?� Initials of site visit staff: L. . Fee Rec: 05 <br /> // o h #: 37 <br /> APPROVED BY LAND SERVICES OFFICIAL: q:14../. <br /> i , DATE: //?7/?2 mm ...,Z.._.--D <br /> UPON APPROVAL: APPLICAN ' MUST POST COPY OF i tf 11 <br /> SIGNED PERMIT APPLICATION IN <br /> PLAIN SIGHT0 <br /> z ga N <br /> vn c. c <br /> Page 1 of 5 P , <br /> Burnett County,WI Land Use Application—Rev 12/2021 1< <br /> a <br /> 3 <br />