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LAND USE PERMIT APPLICATION —Burnett County, WI a 2 <br /> Applicant Complete All Sections Below This Line o N <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .v o <br /> F <br /> ,9 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ^\ <br /> I Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N 3 <br /> Filling/Grading $150 Boathouse $500 w " <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0. i <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. 1. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ql <br /> Ith <br /> Property Owner's Name: I t w J"}-v , R.tC.-t j 8 k o <br /> Property Owner's Mailing Address: 23'I .iw1e1tJe f fa. tillitily 144 c 400; . <br /> r_, City State Zip N <br /> Property Site Address: « i� ��`_� Com:'-)( <br /> Contact's Telephone Number: ✓71 :\-. ,✓S".. 3 Tg 2✓ v <br /> CD <br /> Contact's Email: "t ,f t al-t-r Ac 1.036& f rk4A , C-0"" o g. i <br /> Legal Description of Property: S 1 /--z,, SE-P . <br /> Section#: Lo Town#: "1 b N Range#: 1 -1 W Town of: f (t0.'1 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .» <br /> vi <br /> Tax ID#(1-5 digit number;found on tax statement): t11 I i '1 , , <br /> Proposed Use of Structure/Addition: <br /> !Alcot- check c‘i.t e A r.•,-+434 <br /> Anticipated Start Date: (Home/Cabin;Commercial Ausiness;Bedroom;Deck;etc.) H C t. <br /> r <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z **N1 <br /> 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 bunkhouses.** <br /> rnee+ 4 544 k <br /> 51„,45 - Gr 1N#an kit 4• /1 <br /> x <br /> J <br /> Date of staff site visit: 3 I (#-Q- Initials of site vi 't s . : 1�1,JLr Fee Rec:425-6 <br /> / 6 Check#: 5`7( <br /> 41c„ <br /> APPROVED BY LAND SERVICES OFFICIAL: `� / DATE: 5 ,25r ?2 , ' ....,1-,__J-:3 <br /> UPON APPROVAL: APPLICANT UST POST COPY OF r51 <br /> 1. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co 0 <br /> Page l of 5 y c 00 <br /> Burnett County, WI Land Use Application—Rev 12/2021 Q <br /> 10m ra, <br /> .a Ifilil <br /> Lc:-.=g) <br />