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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line °• CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 )O Addition/Alteration to Dwelling/Principal Structure $200 w <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 'P g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° s <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500vi <br /> D <br /> Permit Extension(l Year Extension-Allowed Once) $100 ° <br /> 2 <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. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> Property Owner's Name: /1 - ' b cc 1 <br /> Property Owner's Mailing Address: s9/ Rieice RcitYLo XJ -a/11 AM 5.rn y ° 1 <br /> City State Zip o <br /> Property Site Address: R 7 4,3 6 Ai V 1'w 1- .Z.� CD <br /> CD <br /> 7. <br /> Contact's Telephone Number: 4 3_I 37 3 O 7 O 6 d <br /> ff <br /> to <br /> Contact's Email: LQ Y 6 lDcLk Ii7C.t . , o <br /> Legal Description of Property: 5 W 5L .)c N 66a S �' . v <br /> Section#: 3 0 Town#: H 0 N Range#: Ie' W Town of: (A.e9r !rC ; Mr.., T( �. <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): C-2 W <br /> (� / ° d <br /> ,j <br /> Proposed Use of Structure/Addition: `Y'C i t-H D n . u...3-el ( <br /> Anticipated Start Date: (Home/ bin;Commercial Business;B oom;Deck;etc.) <br /> '-.3 Q.:.tzl...1 M. <br /> Building Contractor: LArr• 110 ewer Installei�a \- /�j 52 <br /> AREA BELOW THIS LINE FOR LAND SEVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> xi <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to S-- <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhousie <br /> s.** <br /> 0.4ie(l,' 064 +0 eXceeJ 4 o126 Per 50'4 "7Y . <br /> L/ / o Fee Rec: , <br /> Date of staff site visit: ✓(7S/.)'� Initials i f site 'sit .taff: P1L a .)/\,)-(1 <br /> / 6 Check#: A <br /> APPROVED BY LAND SERVICES OFFICIAL: 4." /� ,.,% DATE:5/2 6/2'2 m <br /> zc—� <br /> < V <br /> F) <br /> UPON APPROVAL: APPLICAN , MUST POST COPY OF rnCA I- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 2 c a 0 <br /> '--< o` I N <br /> PIA 115 <br /> u <br /> Page 1 of m v0 © ©I <br /> Burnett County,WI Land Use Application—Rev 12/2021 < r <br /> P <br /> v NJ <br /> �-n <br /> y <br /> a <br /> 3 LTJ <br />