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r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o N <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) d 1.0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F U <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W 0 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . p <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> Filling/Grading $150 Boathouse $500 -, <br /> Permit Extension(1Year Extension Allowed Once) $100 - rk__, <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. g' I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: R a b II <br /> t" —i-" ' K A T f1 L e e A) �y a n S e Ala <br /> we.b.5ta.t( n <br /> Property Owner's Mailing Address: 7 x 7 0 Ai. Q o Ss I.AKe i f ti- 1. S'I8'S 3 = '' <br /> City State Zip o N <br /> Property Site Address: 5 ck_N yl e.._ • L <br /> Contact's Telephone Number: Co I ?- Li I g - S 113 (o 1)— 4.7e1 -3"7/4 - TV 721y i <br /> 9 C7 <br /> Contact's Email: f . ut s Tyr IQ G,.Mo.i 1_ . C 1n D v �° w spa /v N 'c <br /> Legal Description of Property: 311 r 1 'rot-L.- /a ,.5-Gt9 <br /> c,. <br /> Section#: /(Y Town#: 3 ei N Range#: /a, W Town of: !'fit-‘.H 41,1--1 <br /> o <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): 3 3fi9 V ,--3 <br /> x <br /> 1 T o e. <br /> Proposed Use of Structure/Addition: Cnq in 4'9,e_ <br /> Anticipated Start Date: (dome/Cabin;Commercial Business;Bedroom;Deck;etc.) y <br /> W <br /> W <br /> Building Contractor: Sewer Installer: W <br /> '-.Q i 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z a <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 bunkhou/les.** [ �,[ <br /> 40/Uo . 7' J /if e d iJ^ 4u i'N9'N �'f qi//4 �84, ���-++, <br /> � 06 x-91 K prefer, e/`1M J t'I/1 ti/UA a 6.604 tA) /0, 4 d'C71/. <br /> 3 owt„,,,*! e-U`Al t 4'u5e j .ar?4,74.'v atscI4ll e,�ll� ei S 9;it l7 `Y <br /> D � y y <br /> Date of staff site visit: ,c/9'/ZDZ2_ Initials of site visit staff: i7 y Fee Ret' lJv <br /> o Check#: 48J 7 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: , 7��L Z <br /> UPON APPROVAL: APP ICANT MUST POST COPY OFtr <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Fi <br /> R W VO <br /> � /tie,, " m � � � <br /> e Ma s ui1° cyara�e. /S q/- let's/. /D r 6.4,, w es P � N <br /> age of 5 r 7 g N <br /> Burnett County,WI Land Use Application-Rev 12/2021 < w, ' N <br /> V 3 Rv � <br /> b <br /> L J <br />