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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> F.,-.. B b <br /> Applicant Complete All Sections Below This Line O' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d kjj <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K G) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O.,,,i <br /> <. Accessory Structure(Garage, he , c.) $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 P r <br /> 0 u... <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> 90 i <br /> Filling/Grading g/ g $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 `_ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 5 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> P <br /> Property Owner's Name: 'V 'CI\KN\c 1V1( RNA Ho 0A.) <br /> Property Owner's Mailing Address: PIC\ (jO‘y, 9c3`8, Cc(le- W 1 s—I ''U tI rg' v, G <br /> Property Site Address: I ) 5 Pv P OZ, RSO\ 3 ,Qt J't1City J ' State$'yTSC pI ° C <br /> �lg•— - ' \ '—� 15 <br /> g. <br /> Contact's Tel l <br /> Telephone Number: d ,� <br /> Er a <br /> Contact's Email: rf) 1 (-‘05€ Q Li1/41 Q y)i4.;\ NC,Q M <br /> �v� N N <br /> aa tig <br /> Legal Description of Property: 4 � >Co � 3� �� �� a� <br /> Section#: -Vc. Town#: 39 N Range#: I ! W Town of: R(-)...S6q <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 taxstatement): D '�V01 S � ' o <br /> © <br /> Proposed Use of Structure/Addition: t V relc)-`t1 e i h (c , -`'c. ' E3 <br /> Anticipated Start Date: c-KOQ„ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: OL1/4-13"\Q:' •Sew—nstallex: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY .3\ 5 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 'a <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, bunkhouses.* 4t. <br /> e. ' �" hu/'V C_•v/lab r N Fee Rec: 15(J— <br /> Check#:l 3?1d <br /> Date of staff site visit: 6/7717;•7� Initials of si e visit ff: r, <br /> L PI <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: G 60-4,2 d <br /> UPON APPROVAL: APPLICANT f ST POST COPY OF r °CI3 t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a CD <br /> o <br /> Page l of 5 I. <br /> Burnett County,WI Land Use Application-Rev 05/2022 _ , fiR <br /> titis <br /> L,1:-:=1)ro <br /> I <br />