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• <br /> ' LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> • Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200cp <br /> i <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `'----" 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g„ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 El, N 9 <br /> Filling/Grading $150 Boathouse $500 c4 <br /> A, - <br /> Permit Extension(1 Year Extension-Allowed Once) $100 2. G <br /> O <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. g' I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc.U o <br /> Lr .-Ti <br /> Property Owner's Name: i UCJ l/l al Raoi o <br /> Mar <br /> Erc <br /> Property Owner's Mailing Address: ao20,- /3 5°' //2tC i Gk(/1� tut 7.g U i ° c <br /> I I City State Zip o c <br /> Property Site Address:c 74)?/ CIG U))'E '0 I J I b S+'e l- (,U t 5 L/59 J <br /> n. <br /> Contact's Telephone Number: 7/5 - 1 f I - r/8 �5 d <br /> Contact's Email: ClIode_____ illQ 0 00 nt CEJ 0koc,CO (11 N <br /> S' <br /> Legal Description of Property: t7 <br /> Section#: (o Town#: L-10 N Range#: J 5, W Town of: JO CK.SO r\ g. <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): 5'7'"--1.5 -Ir <br /> Proposed Use of Structure/Addition: La r zi <br /> Anticipated Start Date: A L cY 31 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,-3,J j wel3s><z:.e) 9..%.1 <br /> Building Contractor/076e/CAA) Sr/56 L (i_✓I Ai i S Em Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYz 0 V ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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.** (I fs` <br /> d 0w10,6 (059010,b;1 Iv 4.`/ s C— <br /> O <br /> � <br /> ef 'x/04- �f ,4I c f'r b17 � s Fee Rec: (Fl C— <br /> OC�.� �r5 ,IeeJ (IV be ✓€C� ID 1 ^P4l''C�C S Check#: 7 <br /> `v <br /> It <br /> Date of staff site visit: 6/f5/?? Initials of site visit stat • / z <br /> /// <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> iti <br /> DATE: 1/7/?? .C.: :5 <br /> WI g <br /> 0 <br /> UPON APPROVAL: APPLICANT UST POST COPY OFN <br /> IN PLAIN SIGHT 3 <br /> SIGNED PERMIT APPLICATION (3 8 <br /> ll 7 _i <br /> Pagelof5 EI <br /> Burnett County, WI Land Use Application—Rev 12/2021n n 0 <br /> J <br />