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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line c N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> - Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 — 'k <br /> Commercial/Industrial Structure 10 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> , (4 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q` FD <br /> Accessory Structure(Commercial/Industri. —'1 1 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk . Bunkhouse $250 ° <br /> Driveways/&Campground Structures .$125 WI State Statute 59.692(1v)Structures _$350 0 G <br /> Filling/Grading $150 Boathouse $500 N _ <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. W 1`► <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> KA p <br /> Property Owner's Name: V i C Ta(& KA I K R YN PE d TrA . <br /> Property Owner's Mailing Address: //4 51 3 <% ,AJAA f Et.n d Asi v 55-0,1 - 9 <br /> vi <br /> r City State Zip < — <br /> Property Site Address: I/4 7 C.ARSo,v l/2.pCPC'Otirc2 0 tioa <br /> Contact's Telephone Number: 7/3--14/4 p 02/ d <br /> Contact's Email: C 41 ©vt,bow / et s 6. yet ho,, - c:o c-Yt <br /> 0 0o <br /> 0 <br /> Legal Description of Property:WO r `f (SI V 4' 05 7 ( /v bevT Cal )✓ °O <br /> d <br /> Section#: 1 3j Town#: 110 N Range#: ill W Town of: S Co'r-` 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> o <br /> Tax ID#(1-5 digit number;found on taxstatement): /'?Y 13 <br /> ,r._ _ <br /> Proposed Use of Structure/Addition: GAR/ G-� w 64.-rNR0u <br /> Anticipated Start Date: 3N t-`t' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: CitA So.4, i (1,c/)Ell S' lif,C- Sewer Installer: HcPfr%4S- /fade To 6.eli k C4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V" <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouse .** <br /> Nv , ,cCJ( hKl w_ kAsbi-vccr)'"— = Fee Rec:�/ <br /> 63 <br /> ------� � � Check#:—W/6-9 <br /> Date of staff site visit: G/3 <br /> V[�? Initials o site visit aff: m <br /> APPROVED BY LAND SERVICES OFFICIAL: _ DATE: 7 //d'02. <br /> LE 1 "" <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF p W E 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _. -� <br /> ro Q <br /> Page l of 5 ,; <br /> 0 Nil <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> i <br /> �� J <br />