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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line a t� <br /> Permit Types and Fees:(Please,check appropriate boxes) R. <br /> •Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200143 1 <br /> Acommercial/Industrial Structure $�00 r-.Addition/Alteration to Commercial/Industrial Structure $200 �� <br /> cessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industria Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o i <br /> Filling/Grading $150 Boathouse $500 0 (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. V <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1- g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a p' <br /> ` ,J <br /> Property Owner's Name: D/\ / ' t( k e. I c oaPa- <br /> G r� j e-t sk_r G,1/ <br /> Property Owner's Mailing Address: LID e ��� i`'O el-el9-1/i`I 3 cn <br /> City State Zip <br /> Property Site Address: 5A1rn...42— °c <br /> Contact's Telephone Number: 7/c ti t 5 5 s a d <br /> co <br /> Contact's Email: ±k e I be e . �� <br /> y ogo <br /> Legal Description of Property: L..4 Y ( C.S m f / f c 4.0. s. <br /> I d <br /> Section#: II Town#: 3? N Range#: I Si W Town of: b-0-%j Q o 11-t-t <br /> E. <br /> O <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> Tax ID#(1-5 digit number; found on tax statement): q--3(4 ID `4 H <br /> Proposed Use of Structure/Addition: S r-t 95 <br /> Anticipated Start Date: (Z )'6"— ), // (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ...0.Building Contractor: /4y r. (I �•^ S k6 <br /> ' 6,--pc is Sewer Installer: 'f p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY f0 W <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 /> hdditions,E and bunkhouses.** <br /> Mei- kg Se <br /> o <br /> 'Ilk -6 hµ*1401 1 alJt. iC9diFee Rec: /b, <br /> Check#:/ <br /> tA <br /> o <br /> Date of staff site visit: 6l I3(0 Initials of site visit s f• w c--D! <br /> APPROVED BY LAND SERVICES OFFICIAL: 11 DATE: ( 3?,) E"r'i <br /> C: <br /> UPON APPROVAL: APPLICANTNIUST POST COPY OF 0 z n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o .' <br /> r co z NI <br /> Page l of 5 m <br /> Burnett County,WI Land Use Application—Rev 05/2022 < J� <br /> m <br /> a <br /> v, <br /> Y <br /> x <br />