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LAND USE PERMIT APPLICATION—Burnett County, WI g 1 b <br /> Applicant Complete All Sections Below This Line 5' <br /> Permit Types and Fees:(Pkose,d,edt appropriate boxes) <br /> Dwell'ng/Principal Structure $300 Addition/Alteration to Dweiling/Principal Structure $200 I 5 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \\` OL <br /> VAccessory Structure(Garage,Shed,etc.) $150 Addition/Plteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .- r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 O 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 S' N <br /> Filling/Grading $150 Boathouse $500 N <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) _$100 F <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. g+ <br /> `Communication Towers&Signs require a different application form;see corresponding application,and fees. g. <br /> *Mems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc Z <br /> 4 O <br /> .71 <br /> Property Owner's Name: /71 /5 S, ,q. 74/74// /1/1/p TR us T <br /> Property Owner's Mailing Address: ,S/479 /,4 ir''g 02G ROC,'D /71q v uv x2 Y WI S`q'30 i @ 41 <br /> City State Zip <br /> Property Site Address:6/97 L,q k F_ ' RD f?/7 12/q/1/G'v/- y w/ vrY S'3 D ? F <br /> Contact's Telephone Number: 6 /..,?-,7 e o -3,3 F2 I <br /> Contact's Email: ./q!7/= N1/1,//1" 1 f f?/j00. Com <br /> Legal Description of Property:L or 9 C-Sm V /(W P/S (//ti Gp Ai 4.1-) N iv) oa <br /> v <br /> Section#: 3 O Town#: 5/ / N Range#: /S_ W Town of:SiG /SS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.• <br /> rn <br /> Tax ID#(1-5 digit number;found on tax statement): c?/ ' a `7 ' <br /> Proposed Use of Structure/Addition: 6 lig A('£ i t) <br /> Anticipated Start Date: (7- z y / ,20,::2, (Home/Cabin;Commercial Business;Bedroom;Deck etc.) H <br /> Building Contractor://67,4e L o cv a LS E/t/ Sewer Installer: /t/A/ <br /> AREA BELOW THIS:LIl1TE1tOR LAND SERVICES STAPP'CUMMENTSIIdPIBr ONLY U <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> pl <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.** C <br /> 145 <br /> 00IV1e all 5 � <br /> (lJ*k- 4 <br /> f k V� h66, 4' 1 <br /> Fee Rec: /..CD i 41:12-- <br /> N Check#: 5260 <br /> (ala 3 /d-d �� g <br /> Date of stag'site visit: Initials o site visit.�� t: � <br /> • <br /> • <br /> APPROVED BY LAND SERVICES OFFICIAL: ^// DATE:1 6/�3/�; <br /> /14 <br /> UPON APPROVAL: APPLICANT ST POST COPY OFT 1 ffifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - ° -- m <br /> c 411 <br /> =11 <br /> Page 1 of 5 ...1.- Q <br /> U <br /> Burnett County,WI Land Use Application—Rev 05/2022 <br />