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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> < b <br /> Applicant Complete All Sections Below This Line 6" N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> ,( Dwelling/Principal Structure_ $300 Addition/Alteration to Dwelling/Principal Structure $200 li4 i -t <br /> s <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> �cessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 sf <br /> - V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °. —' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 5 0 I <br /> Filling/Grading $150 Boathouse $500 E. <br /> r• <br /> Permit Extension(1 Year Extension-Allowed Once) $100 sss <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. rp <br /> G <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ' r . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> -,1 " <br /> l,J /' <br /> C �ytA <br /> Property Owner's Name: R 1 t l t cl Y . <br /> is;-. C.) -..... <br /> Property Owner's Mailing Address: X0223 HA wn p <br /> so1 VJ) 6,, ` 5 Nth'537..) 3 4C4 <br /> 2�$g� City State Zip o T, Mi%• <br /> Property Site Address: K.11�et re.-- a, V oyet e r5 V;114.. .._ ' . <br /> Contact's Telephone Number: 7 6 —z3 1 l� "��9 cl �`JJ �_� ro r e- <br /> Contact's Email: ? V beytr 509 /44. \ d 6:5 frk N <br /> 0 <br /> Legal Description of Property: 0 7,oZ8`-2. - ^/9.O7-S- )5"---165-01700c, m <br /> Section#: 7 Town#: y 0 N Range#: /Y. W Town of: 5- - / <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): 11 .3/ / f x <br /> Proposed Use of Structure/Addition: -:-4-.L.,....,' ` - e a. ❑ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;jetc.{) <br /> -� <br /> Building Contractor: '.7' _ ) Sewer Installer: s.-- tI/' (, —..c. c\ <br /> w <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 hunkho ses.** <br /> o No- ` 3 b o,,, 5 e,r ,, , l^y p�,�,�54N 22- 1r. z <br /> Cp Areta�y o u v U OG J 5 e 9445ttM r 9� <br /> Fee Rec:��a <br /> IR Check#: 1 aar- <br /> 1� <br /> / 3 zoz� t- <br /> Date of staff site visit: 6 Initials of site visit staff: i / <br /> , I <br /> 0/ZO <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ZZ CD <br /> r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF co rl <br /> c C) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTa m <br /> ' � C) N <br /> 0O O <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 '. r=' <br /> .� m <br />