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LAND USE PERMIT APPLICATION — Burnett County, WI C/1 <br /> r <br /> <. b <br /> cn Applicant Complete All Sections Below This Line ' CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ‹y <br /> 1, X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° "(g.;,,, ` .� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g.) • <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a. <br /> w <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. co <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> -n <br /> Property Owner's Name: C.. i Q L.C S s l 'C£R <br /> 0. <br /> Property Owner's Mailing Address: .At)85 q (..1A-Y-e)09 QQ.\J c. <br /> City State Zip <br /> Property Site Address: (..9(2-4/-r-C-5(3 )(2-12 k..)� t g k 0 N�- ° <br /> rpO <br /> Contact's Telephone Number: 1 c).- .O ( 1. — Li le 0 0 ...0 =D' d <br /> Contact's Email: c-In•-r `%u, ha-C4.—,4- stn o C .oo CS.C o '1 <br /> J N ao <br /> Legal Description of Property: o <br /> d <br /> Section#: Town#: N Range#: W Town of: TP-.PS) t.-Pt 1GE. <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 /> Tax ID#(1-5 digit number;found on tax statement): :-3 0 o <br /> Proposed Use of Structure/Addition: b A-2-ES 0 + •511eE::>'-:L3d <br /> Anticipated Start Date: ru L.y 4:)-0. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) \ <br /> N w <br /> Building Contractor: Ste' L F Sewer Installer: ! A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Q <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to x <br /> ANY construction taking place for any dwellings,dwelling additions,ma ufact red homes,manufactured <br /> home additions,and bunkhou es.* 0 -(^ O� - t tPl 4 in 1/.0. e%veciw ► D <br /> Q PIM c,11 5e-I� o 0,er q(o oe <br /> N�- 4,r hubr AImo► ( I oet _. <br /> �An 5 C� e a ('Ia(.��e0 rof p1 n ee�s ie p ;deI. -i Fee RecP ,, Check o#o: I34I <br /> 1446415°' 13?V <br /> Date of staff site visit: A I?? Initials of site v�it .t-ff• <br /> n <br /> 2 <br /> U <br /> Td-� z �J <br /> APPROVED BY LAND SERVICES OFFICIAL: a /` ,� r DATE: 7/7/e12- Ia <br /> Ifijil <br /> UPON APPROVAL: APPLIC i MUST POST COPY OF m u)to Cliil <br /> > a.o N <br /> f lU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 o N , <br /> W .- N <br /> Co <br /> �� N <br /> Page l of 5 C 3 <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> lC----4-2.J <br /> a <br /> ro <br />