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LAND USE PERMIT APPLICATION — Burnett County, WI a 0 r <br /> Applicant Complete All Sections Below This Line a' N <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> A <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure 00 (S` 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> co <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,- <br /> 0 <br /> 6-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 d <br /> Driveways/&Campground Structures _$12 , WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 N <br /> Permit Extension(1 Year Extension-Allowed Once) $100 . ----7.)\ <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. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> orl <br /> Property Owner's Name: 'J(%e 'Rh hl 0 • <br /> Property Owner's Mailing Address: L/_I O 1 5 4 , r f l l ID 7 V phi V W,- Si a c} r <br /> City State Zip o N <br /> Property Site Address: ;,Sw yk P i <br /> Contact's Telephone Number: S0 v <br /> Contact's Email: (It 7 e G` 74 N 06 • (G i^ <br /> d0 <br /> b <br /> Legal Description of Property: CM <br /> / <br /> P. <br /> x <br /> Section#:Oil Town#: -3 N Range#: I S W Town of: 4 .4 /ff H( 3 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> LA <br /> Tax ID#(1-5 digit number;found on tax statement): q'3 t.-\- - o <br /> Proposed Use of Structure/Addition: A,l 4i fi e- <br /> Anticipated Start Date: J 3 h le 4 J- -) .- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> (' r <br /> Building Contractor: Cf C T Sewer Installer: CiJ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY CIS <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z N <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.** / / / i r <br /> 011 <br /> ..k;I-rc ' Hier la (X1 1°(//Y� /� G"�1 , ` z FeeRec:m <br /> No-/— D e"K �) 'L"'‘S p /y I- Check#: e " 4-- <br /> nQ v <br /> (Date of staff site visit: if C.� z0ZZ' Initials o ite visit staff: //I M G/ rrta <br /> z <br /> o Q <br /> APPROVED BY LAND SERVICES OFFICIAL: r • ' : 6 9 Z 2_,, F3 „ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIG T -o o <br /> /i 5ur�/ ' ' 4ai- -6 co ,,,ile tp0Y�S •by Pa 1 W&2_ 34 <br /> // Burnett County, WI Land Use Application—Rev 12/2021 ' _ �yj <br /> Q/IkteL /Dc_tE fifes T/1S mY► ,5TC/0)4C.- T-qo/a ` C�J <br />