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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> . 0 <br /> Applicant Complete All Sections Below This Line 8' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a 6, <br /> V Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,D'-' 3.1 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < p , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 oo <br /> Filling/Grading $150 Boathouse $500t <br /> f <br /> f. <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 4., <br /> Property Owner's Name: piS- vchb0.k.rey-3 �4pr n(e it c/YI41(ICIa <br /> Property Owner's Mailing Address: 0 30 71 S h v e wc=1 2 Si rt c,`) `-.31-1E-1 . ° E <br /> � • <br /> ^ City State Zip . C E <br /> Property Site Address: \5 h u'tk � <br /> kAiN Q_Ck J i rL .SSS-( <br /> .v1 la-- <br /> a. <br /> Contact's Telephone Number: 7 1 —LI'1I--I I cf 1 d <br /> Contact's Email: y S-et, y-yl..iv-P. L .te-00 .(OTY- o b <br /> Legal Description of Property:Z a o 4 C., nit Gey, � . Qv._ C 1cC cot- S/0 1 <br /> Section#: g 9 Town#: ie N Range#: j 1 W Town of: 4l e g. <br /> a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 35967 i ' <br /> Proposed Use of Structure/Addition: J v e VJ 1 b <br /> Anticipated Start Date:..,-„m•e_ " .60a- . (Home/Cabin;CommercialiBusiness;Bedroom;Deck;etc.) <br /> Tl <br /> Building Contractor:'? \S4—W r: /$�wc*( ' ewer Installer:1Z0ss 1(s1 a.n i S. *Ai c. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 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.** <br /> i f?7e d 5e+�S <br /> Dwe l'o3 AA- Iv C c e4 11 beo(tbe✓is per Ii-2)- 12- , FeeRec: <br /> 1 (7' Check#:C' 1-1' <br /> / r7 <br /> Date of staff site visit: !/3( ,� Initials of 'te visit :taff: r <br /> _ u <br /> d <br /> APPROVED BY LAND SERVICES OFFICIAL: , / / DATE:5/672-0 "";' <br /> UPON APPROVAL: APPLICANT LUST POST COPY OF '.. T r.7,-- <br /> 41 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT --. No VI <br /> „F0 Z.; 00 <br /> 40 3 0 <br /> el.4 IN <br /> Pagelof5 = 3 fig <br /> Burnett County, WI Land Use Application—Rev 12/2021 3 <br /> d <br /> R <br /> C� <br /> c <br /> a <br /> b <br />