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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> N <br /> Applicant Complete All Sections Below This Line 5' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <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 c- \ ...i..) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o I 4 <br /> Filling/Grading $150 Boathouse $500y <br /> Permit Extension(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red 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 - <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a 0 <br /> p Y iC`,)1� ra D ��Cd Pofricc / a de <br /> Pro ert Owner'sName: , v t�J , <br /> Property Owner's Mailing Address: 7 7�5 .J()llli5O�n (mai& /food,, W eb5-fer .. <br /> City State Zin Z c ti <br /> Property Site Address: `5CNNAL Ui Z L!! 73 a q._ <br /> o <br /> Contact's Telephone Number: �( d eY�S(S 6:---S-1) 3 30/ °' <br /> '\ / / ..L <br /> Contact's Email: V Y' •CONI e/r",S C?-1'1 C1 /! G� /k^/l l t •C N 8. aQ <br /> Legal Description of Property: east 112 C �%C II4 G,Vicl6okierrV'YIevdf Led- 6 u: <br /> E <br /> Section#: (9 10 Town#: a N Range#: 1 to W Town of: Oa k i(,ln 4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number; found on tax statement): /3(p 9 4 Sy) -3 k_ <br /> Proposed Use of Structure/Addition: arn a <br /> � <br /> Anticipated Start Date: MCL //! jc �2' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) [ U..—....`. <br /> Vr <br /> Building Contractor: LI)//v e 1�f�i s Sewer Installer: Cilitle/ p /\-- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ..—C) <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 /> 4\T y construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** i <br /> dMe* CdtSSG ��1 <br /> 01,.ey Ailelli 494-6 �` b r4eeI'+5 Per 56IU'NP -? -03 s FeeRec: .3(�` <br /> 6,,,mpe rS be v:54,26* 1 Ah \ 5 /more. a Check#: l�f 6 D <br /> I ' o . <br /> a s. o <br /> Date of staff site visit: "[ I 2 �d" Initials if site v'sit t.ff ` L, z <br /> / a <br /> APPROVED BY LAND SERVICES OFFICIAL: a.�, O. , _. DATE: 5/ " 2-). x ► <br /> < <br /> UPON APPROVAL: APPLICAN ��UST POST COPY OF F E ER <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ©? <br /> T. --- lnir <br /> Page 1 of 5 ;2 o0 0 <br /> Burnett County, WI Land Use Application —Rev 12/2021 r43� o <br /> 01a ti <br />