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LAND USE PERMIT APPLICATION — Burnett County, WI cr b r
<br /> • Applicant Complete All Sections Below This Line 3 c N
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<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> Dwelling/Principal Structure $300 X' Addition/Alteration to Dwelling/Principal Structure $200 d W
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '�
<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
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<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 c
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<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r `pDer`` (/>
<br /> Filling/Grading $150 Boathouse $500 N
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<br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100
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<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. i--
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. �" z
<br /> Property Owner's Name: ' Y Cw..s I\OS r c •dr.i
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<br /> Property Owner's Mailing Address: 7.(;). ?o 020 3 YI-ZbS-�t' W) S9,3 i2 = \1
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<br /> City State Zip C
<br /> Property Site Address: c Xcd./33 1 ;I Lcdt ltv, K(4 ` o
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<br /> Contact's Telephone Number: (p 1,) - -7'41- Noy O d
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<br /> Contact's Email: +r uv Mck.r e c7 gil oo k. (.53r,-)
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<br /> Legal Description of Property:N 5-w(Vv'jtcP1 i 5G-3/1 3"7)(WA's/VI i Ii 9g'9,,,W I
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<br /> Section#: /,;1 Town#: 3S N Range#: /6 W Town of: Al€ j o,,J
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number; found on tax statement): sGJ 7 '1 1 0 ,-3
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<br /> A+ia:hb-� CjG�a�c.. , Lor .-l.,i,h tart. # K,+cA1tr+ 1 `�/ p �
<br /> Proposed Use of Structure/Addition:1,,,,,,j,s a.,�,, e,4>,vt,� Res roa.�. ijo ��,,; me 4.r dr_clru,,:,,
<br /> Anticipated Start Date: (c -.,) - 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.)
<br /> Building Contractor: Sewer Installer: N/.i
<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 /> me additions,and bunkhouses.** 'q..\
<br /> l /Vd- i ex e e1 Z b o s per Sa14i r y /Oc.�l,�i'7`'
<br /> 4 - 19 257. - Fee Rec:r`o1
<br /> c.,,,./46./_ u iG s,le,7/ 7 _ i 77 / P-7 L4/v+2.GtPe-rim/ r, :4 Check#: t47
<br /> Date of staff site visit: 6/Z Z.0ZZ Initials of site visit staff: pi m
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<br /> APPROVED BY LAND SERVICES OFFICIAL: _ _ DATE: l0/ZY�Z Z. ,
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<br /> UPON APPROVAL: APPL 'CANT MUST POST COPY OF g T z ^)
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , o
<br /> Page 1 of 5 .: 3 ham.
<br /> Burnett County, WI Land Use Application —Rev 05/2022 Ll.......
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