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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' N <br /> Permit Types and Fees:(Please,check appropriate boxes) C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 is <br /> N ...1" <br /> ADeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 E <br /> *NOTE:After-the-fact permits(permit aquired after constriction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P <br /> T. <br /> Property Owner's Name: Br e_.4-4- Qn4 }(C(iy S4141,117_ a <br /> Property Owner's Mailing Address: P• O . 1cX Lit 0 L)Qbs4er Luz. 5L( 3 „ <br /> City State Zip < <br /> Property Site Address: e?'{7 514 Sand Lake. silo recS 7reta •° (_ <br /> d% CDa <br /> Contact's Telephone Number: 1.t 5 1- 04 g- I cig .. m d <br /> Contact's Email: rn n W pl Ve. 5 t& OTh l .Goch c P g <br /> Legal Description of Property: Sane)ne) Lam. Sliore.S Lb{-- Is cm <br /> Section#: O 4 Town#: 3$ _ N Range#: 5 W Town of: 1...0.401 I RA'� a, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .. <br /> y <br /> l <br /> Tax ID#(1-5 digit number; found on tax statement): D A5 7 o 7 <br /> Proposed Use of Structure/Addition: Pr � � <br /> V`0L- C.IVttut +0 KW) ��' [' <br /> Anticipated Start Date: ASM) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.))P-4.AL1�yi� H C, __'' <br /> r M I)tsTl l 0 <br /> Building Contractor: Se,1 t Sewer Installer: 64 . <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 /> AN!'construction taking place for any dwellings,dwelling additions,� manufactured homes,manufactured 1 s6 <br /> home additions,and bunkhou s.** (( u0 5 ", to j�c, 4D •ci- WI.i I. <br /> I �'1e - 4 U c , rl _ <br /> P(C€$5o S '1.tee ilo r K4 rha4 kiLbtf -bO'1 _ Fee Rec:4 t'I'1� <br /> Dll°'� U tNR Lies 'Ca ,vtiIS' s Check#:&ti* I0H <br /> ® � L <br /> Oil <br /> Date of staff site visit: Initials of le visit sy- D <br /> / f <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE:5I5! I <br /> UPON APPROVAL: APPLICAN ' UST POST COPY OF Q � 1, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1.1 <br /> -- Nil <br /> w <br /> Page l of 5 a i I..1 o <br /> Burnett County, WI Land Use Application—Rev 12/2021 w 7. N Q <br /> PdiNil <br />