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LAND USE PERMIT APPLICATION —Burnett County, WI a i <br /> b <br /> Applicant Complete All Sections Below This Line 0 i <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 e <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � <br /> XAccessory Structure(Garage,Shed,etc.) 61501 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures E <br /> y pg $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> En <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <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. g' . <br /> jb <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> *rr Si <br /> Property Owner's Name: �re-7 / 41.1e) 6. <br /> 7 p <br /> Property Owner's Mailing Address: Z-3 (3( as A 4W T./ �il(��Lo az- 7' <br /> City State Zip <br /> Property Site Address: i % i ° c <br /> n. <br /> Contact's Telephone Number: d <br /> CD <br /> Contact's Email: <br /> b <br /> Legal Description of Property: Lo 71- / C s Al V. 2.1 /9 /tcOQ <br /> Section#: Town#: 3g--3g--N Range#: D� <br /> W Town of: <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): 3.3C2 c <br /> Proposed Use of Structure/Addition: C G Y Ct 14 , z 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - <br /> Building Contractor: 9 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> xJ <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.** <br /> p (ti eek- all sekb0 W-cci kimcke‘ 4-4 olo ,ors41% n <br /> E <br /> // Check#:f!AS <br /> Date of staff site visit: tC, �/r� Initials of site visit st f• L_ <br /> CD <br /> APPROVED BY LAND SERVICES OFFICIAL: I, . . DATE: <br /> Ill! � r— <br /> UPON APPROVAL: APPLICAN , UST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTo G � <br /> ;3,c Q <br /> Pagelof5 ;,: <br /> Ri <br /> Burnett County,WI Land Use Application-Rev 05/2022 <br /> H <br /> a <br /> x <br /> m <br />