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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' r N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> G <br /> WI <br /> d 1 n <br /> 1 Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '`�� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,, <br /> \ s <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 x'; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> '. 6) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C !V <br /> Filling/Grading $150 Boathouse $500 <br /> !Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> L--- <br /> - <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> 1 CD <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. c g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> o <br /> Property Owner's Name: lenrxe _ _ W—Jrs .+ ___�C Artil C <br /> in <br /> Property Owner's MailingAddress: " I� <br /> P Y7lofo�l - 31 54-A.k7 Pew 5 /-2 y tri.City State ZipProperty Site Address: o22SC� Ey,� [� bl / (� _ ° zc- <br /> Contact's Telephone Number: (,S S <br /> (— V7— mil � <br /> o _ ` "s. <br /> Contact's Email: - --. rl ,d- <br /> ali " r <br /> Legal Description of Property: 40.4.- I C_Slyyk, V..1.2, P!/ (*-3 vicrco) 5 <br /> F. <br /> Section#:_g Town#: tiO N Range#: /ea W Town of: 1a... .. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> I <br /> Tax ID#(1-5 digit number;found on tax statement): I3Agq Icn <br /> c h <br /> Proposed Use of Structure/Addition: ['.• & Q o_ <br /> Anticipated Start Date: �/ /a2 (1 m ,�eiCubin;Comnfial Business;Bedroom;Deck;etc.) -3 �r-- <br /> Building Contractor: 17 b• _ Sewer Installer: /I ,A,, V) <br /> ( <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY F 744THIS 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 I'v <br /> ANY construction taking place for any dwellings.dwelling additions,manufactured homes.manufactured 1 <br /> home additions,and bunkhot ses.*'^' <br /> �141t(y61-� q/( 5e4-O4 , <br /> VD'I Csl7( 1t H,",4 n^, i Fee Rec: 7/5"---0 <br /> 6/02140.1 <br /> / Check#: -7-�l3 <br /> Date of staff site visit: lin. ' of si visit st. % r <br /> - / /2a2 <br /> APPROVED BY LAND SERVICES OFFICIAL: , A, U.4TF,. <br /> UPON APPROVAL: APPLICANT 7 UST POST COPY OF a i oiiiii <br /> n i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD W N <br /> ,,,t, <br /> '1', <br /> Pagelof5 M. <br /> m �C 0 <br /> Burnett County, WI Land Use Application — Rev 05/2022 < ` 1....> c2 <br /> 0Indo <br /> c, <br />