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LAND USE PERMIT APPLICATION -Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5* r4 tt i <br /> Permit Types and Fees:(Please,check appropriate boxes) °' c <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '.6 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q�\ S <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C F. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <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. T <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 5:4A <br /> Property Owner's Name: , t .;: <br /> vt I R is 4 it(4- F <br /> 0. <br /> / a W lo,"-y,,, d <br /> Property Owner's Mailing Address: ' - Z 6 ��` ,`� f- k i cL) `IA °. <br /> I f l/ City State Zi < <br /> Property Site Address: 8/z �' fit;''5 r.d ti4 (%5 r6�. WG 1w l.V,�, 5Y,5 °_ N <br /> • CD <br /> a. <br /> Contact's Telephone Number: 71 5 V 31 I ZG 1 d <br /> CD <br /> Contact's Email: tA't r'1 c h rt r -/Z e V ` ' ( ' C!� Y t 1 LTI <br /> LI <br /> C 0 cm <br /> N b <br /> Legal Description of Property: 6 s D4 S "l 75' D4 W < l 5�1 5 V 5 W W <br /> aqt <br /> r_ d <br /> Section#: U -7 Town#: 3 L)' N Range#: I b W Town of: Pt G c "164 <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 /> Tax ID#(1-5 digit number; found on tax statement): 11 3 16 . o <br /> Proposed Use of Structure/Addition: ��J l'tL 'ND ° d <br /> Anticipated Start Date: (0-It - 1.1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-I -� <br /> Building Contractor: 'C r z'k 5I I kb yvt L) Sewer Installer: e 1(`, ' 'N Ol (i W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY mo <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 3 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to jO <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured <br /> home additions, and bunkhouses.** <br /> ill f AV 5cAcras1 3 bPd�,orrpi S4N-16- 43 <br /> -SrGC O (r - /1//' t S Fee Rec: 3Mc7:� <br /> 3 /Gf c.40 tet' arm.+ �K i.&51_ .��,� dce CF w�i 4/'J Check#: X1 /1 <br /> et <br /> .172 <br /> Date of staff site visit: 6/i }A. Initials of site visit staff: r rn <br /> r <br /> 0,.43421(Ae � ✓le s (404 se er ' ` l C7f 1 1, z C� <br /> APPROVED BY LAND SERVICES OFFICIAL: a_ ', // DATE: 6/$(a� t <br /> < cITEI <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF y .F <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o = - <br /> Q <br /> Page 1 of 5 n 1 Iv <br /> Q <br /> Ifiiii <br /> Burnett County, WI Land Use Application—Rev 05/2022 a <br /> m L s ) <br /> -, <br /> a <br /> x <br /> t <br />