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• <br /> LAND USE PERMIT APPLICATION—Burnett County, WI t I. <br /> ^' Nbe <br /> lieant Ca le'�"we,.A11. S_Mici s Bei'a u1Tb nLin'ei I <br /> Permit Types and Fees:(Please,check appropriate boxes)I 1----- J I .- a ' 1,1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Prindpal Structure J $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> 'ti Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure J $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse ( J $150 n � ' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk 0 Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures ( $350 k' �� <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-AIIovied Once) I $100 1 <br /> I. <br /> 'NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> I IP <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ,�� <br /> Property Owner's Name: &r. -- \) P kQS U-e.. (.2--VA- Ra-e�' � I b <br /> Property Owner's Mailing Address: 13 SST"' < VJ �'`Rt�! (W`' S-..-)11 5. E , <br /> City State zip c y <br /> Property Site Address: 2:2.10A LO-ko r FCt&e..tti&._� �� 'S a <br /> Contact's Telephone Number: _ \SZ-4\7--LiKNO4 <br /> v <br /> Contact's Email: Qyv." c v.i tS\w.t4\© .Log`^ o b <br /> Legal Description of Property: \ cc t ,,a-,i d <br /> Section#: Town#: N Range#: W Town of: ) I 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ..1=> <br /> Cn <br /> Tax ID#(I-5 digit number;found on tax statement): (�\ _ 0[ ` C i <br /> Proposed Use of Structure/Addition: -isl a-cc <br /> Anticipated Start Date: (dome/Cabin;Commercial Business;Bedroom;Deck eta) `3 Q <br /> Building Contractor: ,.--. — Sewer Installer:_ <br /> 'RVABEL1+DWiTIiISWINE4FORILd.NIr RVIGES STFFICOM1VIENTS7C,ONDL T ONSTOl�.3I�71r <br /> THIS PERMIT IS SUBJECT TO- L CONDITIONS LISTED BELOW: ai <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 bunk/: uses.** <br /> Meek- ail Se ac- . <br /> Vim- 6( koilax h /1 • t rli - <br /> Date of staff site visit: ` I f I ?2 Initials of 'te visit .to f: L" I Fee Rec. <br /> / n Check#: 1 00 <br /> APPROVED BY LAND SERVICES OFFICIAL: // DATE:1/,j' Y44 _ <br /> 0.„ AI R , .ANOI. "SWT ROSiT-043 'fes -,F' <br /> e SATED BE °a i iT b141414I:CATII N win 1 L 'NkS1 : T <br /> Page 1 of 5 :. <br /> Burnett County,WI Land Use Application—Rev 12/2021 <br /> ;b, <br />