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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line °• CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) 0a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ F <br /> S. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n (�} <br /> 1 Ne Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> d <br /> Permit Extension(1 Year Extension-AllowedOnce) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E Q <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r- a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: al il K1'e/eN-. E <br /> Property Owner's Mailing Address: /OP 114% I 1 ge1 14 ze/ 6w-t'e1 t. gj E <br /> r/ ,�� City State Zip o N <br /> Property Site Address: / �t� �`'e/e.— L �/ ®�sty6 *fir (�/,�' �j-q <br /> / d c. <br /> Contact's Telephone Number: (� �" S®'- Vg>-> <br /> Contact's Email: dein/ z/ee--14'I4t fre i L/d¢d.L0-PPA N - <br /> Legal Description of Property: "0 <br /> t �. <br /> rit <br /> Section#: Town#: N Range#: W Town of: /t Ss , <br /> *Attach additional page if needed for lengthy description OR attac a c py of the deed OR attach tax system property page.* cn <br /> Tax ID#(1-5 digit number; found on tax statement): 411/ <br /> cJ ) — <br /> Proposed Use of Structure/Addition: ')-'Z .///G, ,19' C�� }.fre4l/cyy FsreJ 4- (j <br /> Anticipated Start Date: S -6-dez (Home/Cabin;Commercial Business;Bedroom;Deck;etc.! : Iko..1): <br /> //( <br /> Building Contractor: OK .4',S 440,-r494.... <br /> r7 Ky Sewer Installer: ,�Q,7•t q L .714.- Tr i <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their I'DC Inspector to determine if a permit is needled from diem prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** r <br /> 00e6-1 a it 4bc(c S <br /> et -1-zpfc� e ),,„0„,, � <br /> tS r i tuir ii t 4 bl" 'i .+ 04y--- y� Fee Rec: 275 <br /> c:21,-- Jef 5c/tek f ti5-e c, Check#: _D <br /> dL-/....-- o <br /> 5 <br /> Date of staff site visit: 07 h? Initials i site visi t r <br /> do 1 <br /> APPROVED BY LAND SERVICES OFFICIAL: 4DATE•5/ 2'p�- „�J. <br /> UPON APPROVAL: APPLICAN -` UST POST COPY OF <br /> Q. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . r ND1 <br /> Pagelof5 =2, <br /> Burnett County, WI Land Use Application—Rev 12/2021 : m 44 • <br /> M <br /> C� <br />