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LAND USE PERMIT APPLICATION—Burnett County, WIcr <br /> Applicant Complete All Sections Below This ; -.0 to <br /> Permit Types and Fees:(Please,check appropriate boxes) a a LR.� <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 /S--' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 jv i <br /> 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 X Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> iv <br /> *NOTE:After-the-fact permits(permit aquired 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. 0 3 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 7 <br /> f 15 <br /> Property Owner's Name: i IA. II ( Kinty nD�CA. Let vie..r a <br /> 4 �M c <br /> Property Owner's Mailing Address: tl 1.. O. Rj&s 97 Vc"c 6 � k? 5 i"D P.T. n <br /> �, `T I (� gsDO City /State Zip < Iy <br /> Property Site Address: .-may e �... y a ` . 1 <br /> Contact's Telephone <br /> Number: 7 I S-7.2-7--.2,..27c...-7 / <br /> Contact's Email: t C7N O in&''Atter e c-c'' 7- <br /> 0. <br /> Lo Y 4 C 5 wt \481 /IR 1, C.1.-01 ()OJtcrt ovule-ve 1-077 3 L�40 0 <br /> Legal Description of Property: pa,-/sh„ 1.0.1-c-, I 7- �444 Var p4,.) o <br /> Section#: U9 Town#: I J N Range#: 15 W Town of: -.71.04-)1 Sy <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system� property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I h 7V 3�0 S yso H <br /> C. <br /> v 1 p f X <br /> Proposed Use of Structure/Addition: dt A ge etrovi^ - KTt D Vt. e <br /> Anticipated Start Date: - , ! . • ome/Cabin;Commercial Business;Bedroom;Deck;etc.) '-3 <br /> Building Contractor: ice I C Sewer Installer: w//4 <br /> tN <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N-- O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if fa permit is needed from them prior to (._ e_I <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured N Y <br /> home additions,and bunkhouses.** L / '/ <br /> C.okc7t ea� .TpG.p�.tl'ae-tc. eki r,tt4. Qrx_4.4 67�''lo e, -K e e,Gt)04) <br /> Je uClo'C kepi' p'` yJl 'M' VP� I IitGi tib r p-1 G7 , y Fee Rec:A. � <br /> lS /f A eeio G/T ex7`C�NS/OH 4 414,9-2./-31/9, AD(,l, L'J� /yds Check#: 79 <br /> Date of staff site visit: 72O&Z- Initials of site visit staff: / 4 7/ z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> Z3A4Pe J <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF rn a fN�l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 'm z nI <br /> I L /- / z W t-a (lull <br /> 0 j ykke, 5 N 7� %A t/_ 4g4, aNc/ %a/,S OR 5 C 'G 70H4S CI, <br /> . 0 o 00 O <br /> Page l of 5 $ ;_ c <br /> © f L �e,,eLe1 Z Burnett County,WI Land Use Application-Rev 05/2022 M '` v <br /> /v T� '�# Z37r�� cn <br /> le.clvtoo AA$ per✓' peel"1 y a <br /> LTJ <br />