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5 eh al J-c) ; i--e igd G ie5:s <br /> LAND USE PERMIT APPLICATION — Burnett County, WI ,„ r <br /> Applicant Complete All Sections Below This Line 0 cN <br /> Permit Types and Fees:(Please,check appropriate boxes) a U1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �R <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 tIS:* <br /> o <br /> g <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 i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °r. <br /> Filling/Grading $150 Boathouse _$500 ,, <br /> I. <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. o -. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: aer'i i De,brA De43o 51't t c 00 <br /> . <br /> Property Owner's Mailing Address: 21.:.�O-13 IV, �i.t k e h C-F. retic leve„ A . �o . • <br /> / Q Cjty / State Zip o y <br /> Property Site Address: „,27115 3;4 t't✓1 5104'L r10a W b 'r i w% �'Jg?3 - � - R <br /> a w <br /> Contact's Telephone Number: 5 (5`”( .20,7 -- VA,, /7 b S 651 _28.5-76'08 d <br /> Contact's Email: A6 b4.dQO g MSM Coni � Ga o W41.1/ o • <br /> Legal Description of Property: sec 0_3 3? 4(nR9 I4, of / $hl f/' 11`7� V G Pill �CS j V 6 tai i) <br /> u. <br /> Section#: 3 Town#: 37 N Range#: //p W Town of: /1/)I[E/l'6/V <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> l3 w <br /> Tax ID#(1-5 digit number; found on tax statement): //I.2 k <br /> Proposed Use of Structure/Addition: //__ �/� t7 <br /> p /yZu> LI /7C/K� <br /> Anticipated Start Date: C //S' e2.2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> H <br /> J j � k::, GLC— <br /> Building Contractor: Skied.ee �i :1,9 GLS Sewer Installer: �y/sr / I c is <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ! . .. <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 /> �e all S e,(-( c1�5 <br /> ��uUC 1(/ 11)v4 , �ooN'1s 0r SI9IV -a2. - 77 Fee Rec:)(� <br /> theft_ �d "1 b ) do - tf Cc C� i� /h�� ('S J Check#: 70 / <br /> tn <br /> cc o c� - h 30 ( fk rrer�d� <br /> i ate of staff site visit: (2/1/2' ? Initials of iite visit to : ,„, r <br /> d <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 6/0p <br /> T-3_,UPON APPROVAL: APPLICANT ► ST POST COPY OF ySIGNED PERMIT APPLICATION IN PLAIN SIGHT z r'Page 1 of 5 Burnett County,WI Land Use Application—Rev 12/2021 <br /> y <br /> b <br />