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' <br /> ' LAND USE PERMIT APPLICATION — Burnett County, WI a ie. <br /> N <br /> Applicant Complete All Sections Below This Line c n 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 c, )1 <br /> 1 o <br /> 1 Accessory Structure(Garage,Shed,etc.)1450914P Addition/Alteration to Accessory Structure $150 .1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °<. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g l <br /> Filling/Grading $150 Boathouse $500 c4 al <br /> A, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> iL. <br /> -'Property Owner's Name: ' �3o <br /> Property Owner's Mailing Address: "Air, a G 1 '' / I " t, Z- E , <br /> /(z <br /> City StateL;)Property Site Address:/ 5 31 2. G�1 e- Rd•, G Ca Sb o(`5l W 1 <br /> — - - <br /> Contact s Telephone Number: `, ,3 ,\ �N <br /> Contact's Email: .--}'li ,./ Ie_.... LIA l' L /( N b <br /> 5o o0 <br /> God" Iq CSA V p154 ( 38g1456� (s Ai Legal Description of Property: <br /> ri <br /> Section#: 23 Town#: 3 q N Range#: 1 q W Town of: W85f• Ci g. '--- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> H -3 <br /> Tax ID#(1-5 digit number;found on tax statement): 3Z 3 5J,y6 4.7 <br /> °Proposed Use of Structure/Addition: ,`� �'�C - Jl c , 09 d� " <br /> Anticipated Start Date: ( ome/Cabin;Comm rcia Busin s;Be/(m;Deck;etc.)� 1 <br /> Building Contractor: Sewer Installer: )%-- N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z 1 W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q <br /> **The applicant needs to contact their UDC inspector to determine if a permit is needed from them prior to i 1 <br /> N <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured n <br /> ommeeladditions,and bunkhouses.** / —l' <br /> 0iMr' i <br /> pei9 %S '6r two 4C.cG �S <br /> e- o' 1c7�s i1'`ef. <br /> ii) /Vol- AV ie.. USe.c/ '' )b" A tAIA"-q te1/4_ (1)e,LIA Aig A • , <br /> c7 <br /> cn <br /> Date of staff site visit: 57'?.T�2�2 2--Initials of site visit staff: �/! Fee Rec:4.51.--e <br /> o Check#: 53�� <br /> APPROVED BY LAND SERVICES OFFICIAL:/9DATE: ✓�/�/�Z Z < <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF cn 1 �'� <br /> a <br /> sy <br /> fu <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z g T 1 C <br /> -g.cD N g <br /> Page l of 5 m o cry 111) <br /> Burnett County, WI Land Use Application —Rev 12/2021 ` w M <br /> ° 3 <br /> a ? r— <br /> � Imo- <br /> b <br />