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LAND USE PERMIT APPLICATION -Burnett County, WI a g
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<br /> Applicant Complete All Sections Below This Line c t�
<br /> Permit Types and Fees:(Please,check appropriate boxes) c.
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v o
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<br /> Accessory Structure(Garage,Shed,etc.) $150 /Addition/Alteration to Accessory Structure $150 ,,..N.3..4„..N.3..4g
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i
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<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 _
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0
<br /> Filling/Grading $150 Boathouse $500 i..
<br /> Permit Extension(1 Year Extension-Allowed Once) $100 w --
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<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. o G
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<br /> Property Owner's Name: L Q>! r-A2,bOr6il-, C6h, t l-k__, I I a
<br /> Property Owner's Mailing Address: e & I (o �. '424 y-r\ ' h IGO kfU k'1 543-C - '' d
<br /> h� City 'State Zip C
<br /> Property Site Address: 2 6,0) Ain j��2.iii i r7 a,,,,,, „
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<br /> Contact's Telephone Number:[ '�/5 �J- C' --- 7e d
<br /> Contact's Email: 6//
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<br /> Legal Description of Property: V;I Ia'9 4 0-C Yeller Co, -he L a Gs in °Q
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<br /> Section#: 3 0 Town#: u 0 N Range#: 1,6 W Town of: ( .(/t,(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): 1 LI soS `” ' x
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<br /> Proposed Use of Structure/Addition: / cr; /7— U'7 .e x' s/,it c> A /e a e
<br /> Anticipated Start Date: ,3/ -Dc (Home/Cabin;Commercial Business;Bedroom/,Deck;etc.) H �'
<br /> Building Contractor: Sewer Installer: n
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 �.
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z
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<br /> **The applicant needs to contact their LDC 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 /> 1' gee Ct E se,-(40,
<br /> �d F,tV X14 +0 L /,� S A)/Ci/� �ePG x Fee Rec: A.SL)�
<br /> �j -� [/'let•✓1 1� h� Ovl 5 C T�ht't �' /u cC�,* ,4 Check#:1-1 L,7
<br /> Date of staff site visit:51102-2- Initials of site visit taff g t-a
<br /> APPROVED BY LAND SERVICES OFFICIAL: :�'lk /ii,DATE: 5//?/?,?--- tr
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<br /> UPON APPROVAL: APPLICANT 'PUST POST COPY OF y
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zN W
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<br /> Burnett County,WI Land Use Application—Rev 12/2021 < m
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