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LAND USE PERMIT APPLICATION —Burnett County, WI 5. I <br /> Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees:(Please,check appropriate boxes) p h? <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a ?,) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 'E.- O <br /> Accessory Structure(Garage,Shed,etc.) $150 .Addition/Alteration to Accessory Structure $150 <br /> iCJ i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c r, <br /> Deck/Stairs/ Retaining ati Wall/Sidewalk Bunkhouse <br /> $250 �, , �_ <br /> A Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> c <br /> Filling/Grading $150 Boathouse $500 -5 <br /> c <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 i. 1- <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. t- 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> P 9 <br /> Property Owner's Name: f1 A ia y 13 e- ' S k t.t.IN e S —r-g_u S -E a `_' <br /> Property Owner's Mailing Address: 10 2 D y I Q.in Co..r--E r11/3,h-�0 inn e A. NW 5 S i i 5 w <br /> City State Zip < <br /> Property Site Address: - 8 0 6 5- S o. 3 0 4, .,5 6 rn L A K e. Rd ° c <br /> a <br /> Contact's Telephone Number: (p ( 2. - 2-0 1 - II -1 3 ( T i r-t. S k u in e s ) 1111110. d <br /> Contact's Email: S 1. Lkn e $ @° ctcmai 1 . C o o <br /> o ~0 <br /> Legal Description of Property: Set A 4..-Lixelkle <br /> P. <br /> Section#: 2_3 Town#: '+O N Range#: I(o W Town of: © Pt K 10.IN C <br /> R. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> m <br /> Tax ID#(1-5 digit number;found on tax statement): t 3 5 ci I o .-3 <br /> PI <br /> Proposed Use of Structure/Addition: i R t Fa- i n t d <br /> P P A � i 0 w ►-�(n .�. . <br /> Anticipated Start Date: (,- 19 - 2. 2- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-3 <br /> Building Contractor: C.In FLA S IlP.A r.d t Sewer Installer: r"..... W( � <br /> 1151 -'1-tb - V,'B0 V` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY --.0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 2 '\ <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 7' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> ho additions,and bunkhouse&** <br /> U)(Ylee--\-- c t1 S 4 , <br /> Fee Rec: A25- <br /> .g. Check#: /o WO <br /> cn <br /> I <br /> 2 <br /> Date of staff site visit:( 'L.5I(/ ,2 Initials of ite vis't t. : tr' <br /> a Q <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �J!Owl!/ <br /> c <br /> UPON APPROVAL: APPLICAN / gii <br /> UST POST COPY OF y N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o =.r.1 I i m ,_ ' <br /> Page l of 5 1 r..1M 1 <br /> Burnett County, WI Land Use Application—Rev 05/2022 c a <br /> d <br /> b <br />