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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI c b <br /> .0 <br /> Applicant Complete All Sections Below This Line 0 64 t,4 <br /> Permit Types and Fees:(Please,check appropriate boxes) ,--. W <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 illS —3 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500CO <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. 0. <br /> *Items not listed above will be treated as accessoryLstructures,such as:pergolas,landscaping,etc. W o 0 <br /> Property Owner's Name: 7( d (/ ecm o <br /> 2 j i.J <br /> Property Owner's Mailing Address: - Lilt /i n &cIv. c45f,,, 5' <br /> En <br /> ')L/ yh It y I-- , <br /> C'ty State_Zip <br /> Property Site Address: �`�.�`V _ \ i01– c� ° g <br /> N° s/'e.o�1/4Gt f .141'' ' ^\ <br /> Contact's Telephone Number: —1,\e"-- '�� C .--" C‘..\ 5 tru citA re., - _ <br /> Contact's Email: �v0� Cta �� <br /> -of\ ` "`5��� N o" <br /> Legal Description of Property: Li \ --\ (- `) .---d•\ `(\ \\ \ --51,\0-23t9 o <br /> v '— <br /> Section#:C Cj Town#:�j N Range#: \'S W Town of: LSC c)\\ �\k k -- _ a <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 /> N <br /> Tax ID#(1-5 digit number; found on tax statement): CV �� 9 Y 0 3 '7 ( r <br /> Proposed Use of Structure/Addition: �w� I� V V C <br /> Anticipated Start Date: ' 5i ? (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I —3 A <br /> Building Contractor: Sewer Installer: (WO <br /> � • W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �Y i. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z L �p <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to O <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured ,A <br /> home aJc �bPy /t4c.,o <br /> 'tions,and bunkh se .** v\))) <br /> 74) �,M 6�i t is. <br /> 3 i....4/ <br /> iv <br /> Fee Rec: <br /> 010eec GoN�;17ON4'1 Id Se, I erIAAl 1—16Y' Q �L A1,44 a 1 lil0�e. s <br /> D GG u,q Orn i v t rMk-/ 4;1+ AIC. 7`. j04j/ 7 e ctiP by 1%h Z,` cls#:�(5A <br /> // 0 <br /> /Date of staff site visit: C� ZZ7ZD ZZ Initials of site visit staff: 9/7T- <br /> rn <br /> r- <br /> '— a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 2 ZOZZ. x <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF m a <br /> m <br /> c ..--,4SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 3 <br /> il)c.ed 604 p,ply -t r sik,crilpess. by 'o/1/Zo t.2. n 0 I,,, = <br /> 6 �J1S ex ah wk, 1k 67o W MCA n01� V' U1 ys0 Me_CpiAPage 1 of 5 rn <br /> -lits P Burnett Co ty WI d Use Application Rev 05/2022 - j <br /> 0 f 4 be used f r Auw.av1 Lletb o r .. <br /> Pluw. l0it.9 4Ito u�e.� /N ?hi 5 !��"GIC7�v`�iv a <br /> � /Uo / <br />