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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line • CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) d b <br /> 7 Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 - - <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 01 ., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 c4 lk <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> i 1 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. S' . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> PC-1,(12A, -n CJS , <br /> —{-- <br /> Property Owner's Name: 1 f O� 4 PC Li t.i i�1�/ ° <br /> b <br /> Property Owner's Mailing Address: I' c P--j> E P' . � 64/it),+ 7 1 <br /> E <br /> _ City State Zip o <br /> Property Site Address: 'A M6 et$ I t . <br /> 0. <br /> Contact's Telephone Number: III / 17 " 6: 61-1 t,, <br /> CD <br /> Contact's Email: 1 L—^C.,o'r+ 8R- 113 4 'CTIN4A 1 L (.O M <br /> 3B. <br /> L' 1fl <br /> Legal Description of Property: Wr y4 p L1 / 1711 I.DT I go <br /> 0. <br /> Section#: 7!! Town#: 4D N Range#: 14- W Town of: . C..G—'T <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach/ tax system property page.* <br /> c4 1 <br /> Tax ID#(1-5 digit number;found on tax statement): �{� o <br /> Proposed Use of Structure/Addition: ii-c 4E L.Y . 1 <br /> Anticipated Start Date: 5 it,^ZZ. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) V" <br /> Building Contractor: /euf-- Sewer Installer: IDU7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x , <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 /> ham ad/Mons, AI( <br /> bunkhouse .** / <br /> (ile.e,F l( Seo q,ditg, <br /> ii <br /> OlACal -1-0 eA'Lbc ';'",y1 <br /> ! DE,r 59 V' !�d"S 3 Fee Rec:JC G� <br /> t Check#: i()it 0 <br /> o <br /> rr <br /> Date of staff site visit:5/10/7P-- Initials of site visit of r <br /> / a <br /> ��. ii 5(C3 a y' ' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: f „ <br /> < 2, !lull <br /> UPON APPROVAL: APPLICANT UST POST COPY OF <br /> am C -"` V V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 2 a <br /> co i--; c.r, <br /> Page 1 of 5 m..?, N Q <br /> Burnett County, WI Land Use Application—Rev 12/2021 < m r.aiiiill <br /> cn <br /> b <br />