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LAND USE PERMIT APPLICATION - Burnett County, WI a `° r <br /> b <br /> ApplicantP Complete All Sections Below This Line a E. c N <br /> CDo , <br /> Permit Types and Fees:(Please,check appropriate boxes) a U.1 <br /> v <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 n) --- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 —.: 7p <br /> Accessory Structure(Garage,Shed,etc.) $150 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(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 N t <br /> Permit Extension(1 Year Extension-Allowed Once) $100 g. M <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. o <br /> -11 <br /> I t' <br /> Property Owner's Name: i.4.Gc2 reel(..:C C�c ` i►'�1 Lyric ''J c,v.,% 0 r <br /> Property Owner's Mailing Address: 3�1`lC� C 4e- aLe tird le- Al AJ 'S 5G4f4° = (- <br /> City State Zip C <br /> Property Site Address: 4'1/9° f n Z-14- 6'1.- d', i biGr 4t1.2' �g5 c �� •o a <br /> Contact's Telephone Number: 4//2-61/4/-8 ,-,1 33O.d <br /> Contact's Email: `/u^d26e''755 c(,0,M'-:c' > /. b ....,1 <br /> Legal Description of Property: I /n , <br /> Section#: Town#: w N Range#: 0 W Town of: (�Ci,��4' 0. `4 <br /> n --C <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): I 05° f <br /> Proposed Use of Structure/ ddition: /j c`',41/^e.)0rt--t d <br /> Anticipated Start Date: t/n /f 2 Z Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `3 c <br /> Building Contractor: (7 y Ur / <br /> e Sewer Installer: • p kt ns <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zit <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 bunkh'puse ** <br /> reek all Se-1 �5 1 f <br /> f t• io+- 4, eAfeed 2. bed irddfits p.e i .51W- 17ggc <br /> Fee Recqt ae <br /> p''JJ�a ,M er/•v�> juC�- crCC/� <br /> .-i Fee <br /> 702 <br /> -7) <br /> o <br /> Ill <br /> Date of staff site visit: 51101a? Initials of site visi st:ff:�L <br /> fL::::-i) <br /> APPROVED BY LAND SERVICES OFFICIAL: : •i,„ . d DATE: 6§/a1,02- <pJi J ro <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF _� c 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r4cb <br /> Pagelof5 pon me <br /> Burnett County, WI Land Use Application—Rev 12/2021 1 <br /> ! <br /> 3 <br /> b <br />