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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 3 t � <br /> Permit Types and Fees:(Please,check appropriate boxes) cl. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200kCommercial/Industrial Structure $300_ Addition/Alteration to Commercial/Industrial Structure $200 \,. <br /> 0 <br /> "( Accessory Structure(Garage,Shed,etc.) $150_ Addition/Alteration to Accessory Structure $150 pQ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk .Bunkhouse $250 � �� <br /> Driveways/&Campground Structures .$125 WI State Statute 59.692(1y)Structures $350 , P 1�7 <br /> Filling/Grading $150 Boathouse $500 j ,, to, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> v <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. -c <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o.. r- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> -r: <br /> V <br /> Property Owner's Name: ‘:::›e_O✓{�� t mat �Ol1Z c <br /> l 11 J( n <br /> Property Owner's Mailing Address: (10 --`1 1.,(TT Le Tk lb ' hic-Ivf-1 <br /> City State Zip Z <br /> Property Site Address: .� (, r. <br /> Cl ,Ct 31> 2-' <br /> Contact's Telephone Number: <br /> (oS/ - a-35 - 35 1/ ° 7,, <br /> Contact's Email: e / W//d 5s ® L{ )©Q C Jstvt NE. <br /> -� <br /> Legal Description of Property: (oT 6 C- , 3-2-13 <br /> Section#: Zli Town#: ' 7 N Range#: l W Town of: t 2 v{-y- a_ Lot1L4 <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): 7 C.- <br /> °-3 <br /> ..„3\�if V?k‘-‘44..p - t) I LS t+-7)p <br /> ° <br /> Proposed Use of Structure/Add'tion: <br /> Anticipated Start Date: � / Sa (Home/Cabin;Commercial Business;Bedroom;Deck, etc.) <br /> Building Contractor:V.1-0 vi + %OWL Sewer Installer: k l ,, W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY % W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (J1 <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 hones,manufactured <br /> home additions,and bunkhouses.** P( <br /> �( ` G( h of /a�- �r <br /> til, )(leech)(leechk CO z Fee Rec lb)(Li <br /> 0,? 4rVI'p� 5�v ce, a t ez,l e Check#: 445 <br /> e <br /> rt(:)cici -}�r l <br /> r l <br /> Date of staff site visit: /3/�jZ Initials of s' e visit sty : :�V- <br /> / aQ <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> /91r <br /> DATE:. /`�/�p� (T{ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -, g N o <br /> Page 1of5 ^' �l <br /> Burnett County, WI Land Use Application—Rev 12/2021 < E. <br /> o <br /> --7 <br /> ate" <br />