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LAND USE PERMIT APPLICATION -Burnett County, WI = <br /> Applicant Complete All Sections Below This Line sTN N <br /> Permit Typesaid Fees:(Please.check appropriate boxes) <br /> i= k <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2 •,` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> • <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> t3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. `i° „p- <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r g _ <br /> CA <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o( r—' <br /> NIm <br /> Property Owner's Name: CL-V^-�--c �j 0 <br /> Property Owner's Mailing Address: c2 9 a 9 S V)'{?,ty‘- ,. l.ac JSr', L,.5cl j ' r) <br /> <� Uln . ' City State Zip <br /> Property Site Address: 'Ss7 Ci e-,v ) L._)� 7,}--t=r. �,,;t,,. -t s�k"-i 3 .°— Cl) <br /> Fa. <br /> Contact's Telephone Number:CI I Fj ) Y-1 j d <br /> Contact's Email: C._L \cl SiC\_ -e.`' v1,‘...e., L A . e C11 <br /> �✓ o oo <br /> Legal Description of Property: s.r Z. <br /> L �- 1 C_„. S \"..\. 5- 1 3 1 Vr. 9?1 w <br /> V. <br /> Section#: , i f Town#: 46 N Range#: 1' W Town of: --.V.. t..-5o".. I. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* irso <br /> En <br /> Tax ID#(I-5 digit number;found on tax statement): 6 Es t-45- <br /> Proposed Use of Structure/Addition: (c_Ck .ECN-1 z_._ O <br /> Anticipated Start Date: 't) <br /> — / — .2 C. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) --3 <br /> J- k-(� <br /> Building Contractor: ��,_lAk� \--6,,p ,S Sewer Installer: /- V . 5 a t.)) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <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 m <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home ditions, and bunkh uses.** <br /> (,,(- fl1Pe 1--a(( 5efbc 1 �-1- <br /> 414-- <br /> � sct� P� e�� 1 i1e c r�- �� 1� <br /> -k,' • Sunle ✓r 15 Ile t a J k c 15e4 S" ' <br /> ( ^Vh Vi*. <br /> - 0. CC1t 'h� ��� Oe.' Q T+�' (e/I9fvuc,�t Fee Rec:A/.�•0— <br /> Fee <br /> nee' la.t Ax ter <br /> r,,Aleit M Pum} txcuseMoir 3c d•�l itsfxt i ,n yfeatr, Check#:__ <br /> 111 <br /> Date to site visit: D Initials of site visit staff: �' rz <br /> IJCce.05o MYtA ie- coo /V ` 0, v�'- . -f 64114 ka ; .�a 4• I ��) <br /> APPROVED BY LAND SERVICES OFFICIAL: Baa. , r�,4 DATE: i/5A?-,2 <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Q <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 05/2022 r <br />