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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes)' d <br /> '-'54k Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 6"-- 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 n t, 4 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a ---A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 k) ii. <br /> Filling/Grading $150 Boathouse $500 w <br /> Permit Extension(1 Year Extension-Allowed Once) $100 g. <br /> w <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. 5' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. osist -n <br /> iiPropeOwner's Name: hi a is f 7 C,h (, S 7 er ,� <br /> ,777 5 // / r 5'/Lei/ �� . n Ca vV\ <br /> Property Owner's Mailing Address: Q(� 7 f'/��/I C (.0 i --( '' V� <br /> City State Zip 77 o N - <br /> Property Site Address: _)C,fl'.e <br /> Contact's Telephone Number: 7/c-'7 (S - Z5 71 "'c 7.5 - 6(757 -( 7 /t :,..0 -K <br /> CD <br /> Contact's Email: 5F'/'(1,) 11 iic l7C,t/1143f-P -' 71:' gT., 9 i'l'l4c /-7i/71 o <br /> cro <br /> Legal Description of Property: °a y <br /> Section#: Town#: N Range#: W Town of: g. V <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): F <br /> Proposed Use of Structure/Addition: bly \-1\)Anticipated Start Date: S -1 7'- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `� <br /> RS 1.:sio <br /> Building Contractor: , ; ' C Sewer Installer: / ,(-,-;��' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 /> home additions,and bunkhouses.** <br /> Q7 mel(l1^ OF 42 exZet 3 b M-5 ped silly-L'- <br /> Fee Rec: v2n0— <br /> Check#: tl766h <br /> /I (?,2 <br /> Date of staff site visit: / 5 Initials of ite visit f: ( :=1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: v( 7/ a rT1 A) <br /> < a -. 0 <br /> UPON APPROVAL: APPLICAN UST POST COPY OF 'm co o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z o= p <br /> � <br /> � N C <br /> Page l of 5 13 <br /> Burnett County, WI Land Use Application-Rev 12/2021 < C� <br /> o <br /> y <br /> a <br />