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LAND USE PERMIT APPLICATION — Burnett County, WI a `° <br /> Applicant Complete All Sections Below This Line ° CD N <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 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> X Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0or- '-:,,) <br /> Filling/Grading $150 Boathouse $500 � <br /> Permit Extension(1 Year Extension-Allowed Once) $100 '- <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g. -, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o R <br /> 6. <br /> Property Owner's Name: ROn <br /> lvA1.O SwAu SUIS b <br /> 67 n <br /> Property Owner's Mailing Address: 0 Utk IOR, t.iLin <br /> vi <br /> �, <br /> `/ City State Zip o N <br /> Property Site Address:/JJA r Al2dk 51 (A) a <br /> Contact's Telephone Number: 65 -29$ 52/6 0 <br /> 0 <br /> Contact's Email: /b)J$(.JG../U 26 e?HA 11..Cf-V N ba <br /> Legal Description of Property: W A. tfo <br /> ' <br /> P <br /> Section#:2„..5— Town#: 4/0 N Range#: 7 W Town of: a/V/UYv DI. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> PP-7110b -3 .-3Tax ID#(1-5 digit number;found on tax statement): 25066 f Ei <br /> Proposed Use of Structure/Addition: t k,h 7ti jQ-e-c k F 11.--47-k �-- <br /> Anticipated Start Date: 3Z-5 (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) ,H Cn <br /> .11 <br /> Building Contractor: Sewer Installer: /40116 tiS O <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 dw lungs,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkh uses.** <br /> Omer a Lr 5 r(- <br /> t,E/C4 %'S <br /> Date of staff site visit: q` `p- Initials of s' e visit s Fee Rec:/ 5(:- <br /> z <br /> z Check#: '71(� �7 <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: L72 _ _�_C3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' �,�, �'�,� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT W a <br /> a na 511 <br /> n <br /> CO Pagelof5 3 c; Q <br /> Burnett County, WI Land Use Application—Rev 12/2021 �'` v <br /> Ril <br /> a �......) <br /> K <br /> -0 <br />