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LAND USE PERMIT APPLICATION - Burnett County, WI a `° r <br /> cAPPlicant Complete All Sections Below This Line 0 N <br /> CD <br /> , <br /> Permit Types and Fees:(Please,check appropriate boxes); -; ..t, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <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 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> g ----\ <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) $100 S <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r- §. � <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ` <br /> �' L' �/ -rii ,n R <br /> Property Owner's Name: I JmG']1'f t /xi«�f b <br /> ,,,, 3, - <br /> Property Owner's Mailing Address: 0 7g1 Lori j61570 'sJ"Ye/1 tt / ,3-482 . r) N <br /> Pio <br /> city State Zi <br /> Property Site Address: /i j .,O'n�z.1, 76 ...S\iwi t11I L V'7 <br /> F. <br /> Contact's Telephone Number: /[$ -(24 - 6 Fs/ d <br /> Contact's Email: "Gt c I t q ,e.i�{'f 1-,-; ` r pot- N o0 <br /> Legal Description of Property: °0 <br /> Dail d <br /> Section#: 1.1h Town#: S8 N Range#: 17 W Town of: Da n tie I S g. <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): x"0043 'Q 0 <br /> sfi®1`a5 <br /> Proposed Use of Structure/ dition: e, :— <br /> Anticipated Start Date: IAL Atoy (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:On; p, q Glt kilikioS Sewer Installer: 1 <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 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 1 <br /> home additions,and bunkhouses.** <br /> 0IVO't- WI ,/'m h 461,4'42Ie511.6cpi iciiii??-- Check#: 9r5Z) <br /> Date of staff site visit: 5 Initials of site visit staff: //1 r <br /> APPROVED BY LAND SERVICES OFFICIAL:624DATE:5/ /342a x fiii <br /> a <br /> UPON APPROVAL: APPLICANT;MUST POST COPY OF S W W --Z- 0 <br /> 4Wac- II <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT --a. 0 c <br /> Page lof5 g1 U� <br /> Burnett County,WI Land Use Application—Rev 12/2021 - LE: V <br /> i <br /> -0 <br />