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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> • Applicant Complete All Sections Below This Line c tJ <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <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 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ..: .: <br /> Filling/Grading $150 Boathouse $500 <br /> r R <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ?. <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: .j H 4- I"(�EGG ,. ._ii-o .-2.' C <br /> c r7�96 t= <br /> Property Owner's Mailing Address: 7/9 ' \/,, c�� S 1 41 C,ACV Ahe 5s0L <br /> 'Z 1-flpo- . <br /> City State Zip <br /> Property Site Address: 17'c Z 6 rte-p /2©/1.-e Lair ,5'5/893 ° N <br /> ` <br /> 5.'-n ontact's Telephone Number: 45/- 7,'S' 1gra>ct p . d <br /> Contact's Email: Tf/Li, S-cFf-(SON 6E-gci es/tEEHy Con1,5772UCr1bN, COey <br /> 0 oa V <br /> 0 <br /> Legal Description of Property: 0 7^ O/4 2 - ,j$ -/S-( 5O3--^ Ocz -- 02/b c C. <br /> P <br /> Section#: 4 Town#: 3 5 N Range#: 1,5 W Town of: L A & t_L N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> En <br /> Tax ID#(1-5 digit number;found on tax statement): 97 $8o H <br /> Proposed Use of Structure/Addition: ��-n� <br /> h;:::'') . d <br /> Anticipated Start Date: file P/ Itti/7 L',4P 'Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ( —1 <br /> Building Contractor: :WE-Oce./A.) Sewer Installer: A/;, rc., 5fri--&—P W <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 70 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,Land bunkhouses.** <br /> ©�mT 71 6e:. used 'TSDN AuWte�N 4a 40//�'TOV! , <br /> -3 <br /> Fee Rec: /56� <br /> / Q Check#: Le 2 <br /> Date of staff site visit: 7 <br /> Z 27 Zit?ZZInitials of site visit staff: J"� , c- <br /> /( Q z r I LZ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 03/249 a ZMI I- <br /> X SO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N g Oil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o a G� <br /> z � C N o <br /> 'ate Ns) <br /> Pagelof5 <br /> 510 <br /> Burnett County, WI Land Use Application—Rev 05/2022 < R. <br /> v <br /> 3 <br /> -o <br />