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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> ' <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 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 •\1 -. <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << U <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350P ^ <br /> Filling/Grading $150 Boathouse $500 cro 110 <br /> AD <br /> 5/ f+- b 2 / a• S r2 c Permit Extension(1Year 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 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o e <br /> Property Owner's Name: GC ir a -nue l/r fi/Yl s/ylt 1-h <br /> / <br /> Property Owner's Mailing Address: 7t/j_1 15/"' p.ue S g, c.AA-r m ,,J 5,5-'1 Z3 i <br /> j City State Zip <br /> Property Site Address: 2 3`7,f-7 ,fie hr., due 1st rt t"Lo SL-er1 ("Xi,' f yf7Z - P <br /> Contact's Telephone Number: 47 / — y Z— 4. SO2 d <br /> + <br /> CD <br /> Contact's Email: S rh 1 -1--In t/"]k3 e /t Utz'. c b n7 N <br /> Legal Description of Property: o <br /> Section#:) Town#: 3? N Range#: / 7 W Town of: ,e Is — eu rre-H— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> zn <br /> Tax ID#(1-5 digit number; found on tax statement): o'1;•>.) x <br /> d <br /> Proposed Use of Structure/Addition: jekkety.5432 AZA, PCL:h 6 <br /> Anticipated Start Date: _5—— I-- �9,.. (Honte/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> -3 <br /> Building Contractor: pAn Fr o dee r1 Sewer Installer: 1/11 A c a, <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 GDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for ant'dwellings, dwelling additions, manufactured homes, manufactured <br /> home additions, bun torrse�;'1 � �� <br /> 5 <br /> 15pa-4)17. o/i �`t� P/ i;-i Fee Rec: -t"��— <br /> PCheck#:I 3 <br /> o <br /> Date of staff site visit: 5/31?)e. Initials of ite visa t. f*:� Z:", a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> P, , sq/2)- a rl u� <br /> UPON APPROVAL: APPLICANT ► UST POST COPY OF CD CO N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT MI <br /> 0= N o <br /> Pagelof5 egill <br /> Burnett County, WI Land Use Application —Rev 12/2021 <br /> -I <br /> 6 <br /> ro <br />