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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> ApplicantP Complete All Sections Below This Line g c N <br /> Permit Types and Fees:(Please,check appropriate boxes) n' <br /> d b <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 .. 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 - 1 <br /> v <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits (permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. or g <br /> • <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> o <br /> r <br /> Property Owner's Name: C) i1 Os-- ` A. < I In n o V\ a 0 <br /> - � (jII w <br /> Property Owner's Mailing Address: -(Q 9 c.- <br /> ` Cb 0 '"` ,0l� L✓\ PC 4 Spm t1I �,- /erg- <br /> City State Zip <br /> Property Site Address: S OwY� � ` ° G <br /> Contact's Telephone Number: (7f 5 Y-Ss)-(1 <br /> CD <br /> Contact's Email: itif A- AA,, o <br /> � <br /> LOg <br /> egal Description of Property: �/v o <br /> l d <br /> > <br /> Section#: 3 G Town#: q N Range#: I W Town of: 2 v._S (` <br /> 5'. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '" <br /> En <br /> Tax ID#(1-5 digit number;found on tax statement): I O \t <br /> °'- <br /> Proposed <br /> Proposed Use of Structure/Addition: I 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> 1 <br /> Building Contractor: Sewer Installer: (� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z v i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z v. <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured <br /> h•me additions, and bunkh uses.** L <br /> a /'Vertu /mcl�t t I tet i 1, g'r,eAL ht 14 k$ 6 y 9 i I / ZO L 2 <br /> do Co t4T'c U O N S/1 e-c- 4 fD See- /F ht_ X 1/1 i 4GCQ' Fee Rec: <br /> P�,1/'/M/1� 4it' /NS/eCtf6°11$. y Check#: � 77 <br /> VA/of <br /> 1.37e. <br /> Date of staff site visit: � 0 ZZ— Initials of site visit staff: / /I r <br /> z `_. . t <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 6 jZd Z Z ,, �^J =J -J�J <br /> iiiiii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' i n <br /> Z 0 SIGNED PERMIT APPLICATION IN PLAIN SIGHT z Cnl� <br /> -< <br /> Pi <br /> Page l of 5 �.� Q <br /> Burnett County,WI Land Use Application—Rev 05/2022 < _ MI <br /> c, `�) <br /> v <br /> a <br /> x <br /> .v <br />