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LAND USE PERMIT APPLICATION— Burnett County, WI r
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<br /> Applicant Complete All Sections Below This Line 5 N
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<br /> Permit Types and Fees:(Please,check appropriate boxes) (,`
<br /> Dwelling/Principal Structurer, xJ
<br /> $300 Addition/Alteration to Dwelling/PrincipalStnicture $200 � Gl
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 9
<br /> y/ Accessory Structure(Garage,Ae )etc.) $150 Addition/Alteration to Accessory Structure $150
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C.-
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° e
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350
<br /> Filling/Grading $150 Boathouse $500
<br /> Permit Extension(1 Year Extension-Allowed Once) $100 a
<br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. f
<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g .
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o
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<br /> Property Owner's Name: t c•--c ,ci. (.,,,i,2 ,-, ( G(CSP
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<br /> Property Owner's Mailing Address: Z It cl SS w c-,47/s. (D 1- V,L}<.'.c /�1;�! 3 . 4
<br /> City State Zip e
<br /> Property Site Address: 41 SC) `i z_ VAS;hc2,, h r, 0 c.„,bc,.,<.\ 1 L-1c'- s.3 C) ° I
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<br /> Contact's Telephone Number: 6/ Z -6 /c/ -S �S- 7 5— d
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<br /> Contact's Email: cLi c..: e , , Ll c IJ G-)5/ l /. «,-,
<br /> Legal Description of Property: L,;f 6 ' ) ,�u,f,A e 41.-19-1/7 7 7«s it,,,�.„vc>i<..-e. pi,, z t z c...<�i z 2.3 yi,i i izz, u
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<br /> Section#: 2 6 Town#: PI I N Range#: i C W Town of: S 0-,,A-c.f1 L&,t-,4zJ, c-J f r`,'15.i\
<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 it(1-5 digit number;found on tax statement): Z_ I (,''i .7
<br /> Proposed Use of Structure/Addition: Pc I e .5 1,4._ T"
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<br /> Anticipated Start Date: ,5"--,,,A e 111 Z c. . L (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `3 C-'
<br /> Building Contractor: SLir,,,,. f . lc S ke,k --'in...,'-c,,‘,uC Sewer Installer:
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<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<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 /> 0/1(leekft1( Se -bcsoks or lots - be- P.4.4?
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<br /> ` Fee Rec: r.
<br /> ® (vim- k,„( Min t ��v 1 y ,Check#: i
<br /> Date of staff site visit: 5//©l2 Initials f site i ' .taff:6/12- oa
<br /> APPROVED BY LAND SERVICES OFFICIAL: /, /y• DATE:51/21P - c3
<br /> UPON APPROVAL: APPLICAN MUST POST COPY OF a 3. IIiit
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - t a Gifil
<br /> Pagelof5 1 rl Q
<br /> Burnett County, WI Land Use Application—Rev 12/2021 < .
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