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LAND USE PERMIT APPLICATION —Burnett County, WI a c <br /> s <br /> H N <br /> Applicant Complete All Sections Below This Line g a N <br /> Permit Types and Fees:(Please,check appropriate boxes) o Z.), <br /> 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 <br /> F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(l Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. - 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o l+ <br /> -n <br /> Property Owner's Name: ( � c` 'I l/�;. s_ ',.. . 1 <br /> n p n <br /> Property Owner's Mailing Address: (�36 �j f)((, Ct 1 L I�IL� t DV �Lf/,s a 5� k <br /> J�� ��� ,J Cit J State Zip o <br /> Property Site Address: til IP2l Irlay i vi IA.�- Ea <br /> Da 0f u _ <br /> 14 �� a <br /> Contact's Telephone Number: ,703 &4 c) (� r (' d <br /> CIO- <br /> Contact's Email: (iLaic et Y 0 I t v2. Gown o b <br /> a <br /> • <br /> Legal Description of Property: Leo to roar-s Sunctzv,sit), e)(C- Ni, I it ;)C °O <br /> d <br /> Section#: 0 3 Town#: y Q N Range#: ►4(D W Town of: M <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> v) <br /> Tax ID#(1-5 digit number;found on tax statement): �� ' x <br /> / ��� z e <br /> Proposed Use of Structure/Addition: (4*1 v•- <br /> Anticipated Start Date: Play ( t 7,0 -L $.7t ----(Home/Cabin;Commercial Business;Bedroom;Deck;etc.)Building Contractor: 04,,JQ (i;hslift i Sewer Installer: Ctv 106-c6.Ikt-+-i — <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 <br /> home additions,and bunklious ** <br /> i ie-f- .1( 5 e-Fbe. 5 <br /> �"'e(6)/1 n* -f exceec( q becjl°"' f)cr 54N- -5to <br /> va <br /> Date of staff site visit:5477?9- Initials of site visit staff . t p Fee Rec: O'' <br /> /// ,// o Check#: �"��, <br /> APPROVED BY LAND SERVICES OFFICIAL: W / DATE:-/?2/ �� <br /> UPON APPROVAL: APPLICANT UST POST COPY OF ad 'Vi ITN <br /> —. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zx <br /> CD CD• Pagelof5 m sp. INEI <br /> Burnett County,WI Land Use Application-Rev 12/2021 o o a' c:=I <br /> G -15. <br /> b <br /> L✓ <br />