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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line ccil N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure X . <br /> $200 o <br /> X Accessory Structure(Garage,Shed,et 9 '$f50' Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o bp <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Permit Extension(1Year Extension-Allowed Once) $100 `. re <br /> d , <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. q $ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> *11(' , 1' ,. <br /> Property Owner's Name: 5V,JSh/Ale 11\Q Svr-t' r,'x ' <br /> Property Owner's Mailing Address: `) 0 031 M a - o rD ST 36/6e at_ 60099 <br /> CI <br /> LIIoAS <br /> (� City State Zip < - 1 <br /> � <br /> Property Site Address: I I 17 CO ' / !�(X sp�le(' ��1-1- syt,/ CD <br /> Contact's Telephone Number: 908-31 y-1y/y d <br /> n) <br /> Contact's Email: 3 PC,S(Q O M A I • (Qin og <br /> JJ o <br /> Legal Description of Property: 004 J-110), 'JO 3 goo d <br /> Section#: A y Town#: 9 0 N Range#: Ili W Town of: Sc 677--- a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> c4 <br /> Tax ID#(1-5 digit number;found on tax statement): iu lity <br /> Proposed Use of Structure/Addition: (f\P A 6-e / Pok &A ) CST0A/16-e'\ <br /> Anticipated Start Date: J (Home/Cabin;Commercial Business;Bedroom;Deck; c.) H ...-- <br /> Building Contractor: f 1 A ASE S tl l hO 9/J Sewer Installer: H QP IC/,a'$ S4 f.iwry <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zCk <br /> **The applicant needs to contact their UDC Inspector to determine permit is needed from them prior to I <br /> if a <br /> 70 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhou es. <br /> f)e,4-�' q,4 15� 0 <br /> Na-f-fir kms, Ata ' �1,` <br /> rr__ d i7 ,� Fee Re <br /> 5��� 'leek 5 -i b$ /`�° �a Over dra:vi �2/d' P Check#: :sx..-‘15°9T <br /> r P o <br /> rn <br /> Date of staff site visit:J nr/e/a - Initials of/•te visit sof • lit, <br /> _ <br /> / z <br /> APPROVED BY LAND SERVICES OFFICIAL: /� 7: 0„, <br /> DATE: 5/17/Pp- rn <br /> X C <br /> i <br /> UPON APPROVAL: APPLIC MUST POST COPY OF75 g <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> W <br /> C <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 t 4 <br /> m <br /> 0 <br /> -i <br /> a <br /> 6 <br />