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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' =a. w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 11— <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� `\ ~ <br /> )( Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 k) <br /> Filling/Grading $150 Boathouse $500 <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. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> Property Owner's Name: flDbXet CO►r,SOn sii MRt i...CheLSAN a .-{- <br /> 47 n <br /> Property Owner's Mailing Address: ° D <br /> City State Zip -f <br /> Property Site Address: Ago» S1Crug.147` lip U!E 6 STE'K WI' S51Q93 - G <br /> Contact's Telephone Number: 3 P C <br /> p ���, y�. Q�� w <br /> CD <br /> Contact's Email: 10CCCIto f1 (=q 1)ek Q�Crlal\.Com <br /> I L ✓� / N vo <br /> Legal Description of Property:`g'1 I t5� �1b (/0 8 .Q 1 i,6 0 <br /> d <br /> Section#: f?-'' Town#:f4t9 N Range#: 15 W Town of: T/l-crksnw N <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): 3 5-' 9 G <br /> Proposed Use of Structure/Addition: pr{/( ° C <br /> Anticipated Start Date: MI N9 26awl_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: JSewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O ..9 <br /> al, . <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 bunkhouse .** <br /> Thee4- kit 5 c <br /> Fee Rec: <br /> 5 Check#: 3 <br /> LL v <br /> Date of staff site visit:6�lJl a� Initials of s' e visit f E. <br /> a <br /> cp <br /> �� P z <br /> r C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1LJ l r� x <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N ; i-.... i Iii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> z 5'm v 11 <br /> ar n a <br /> Page l of 03 0 <br /> Burnett County, WI Land Use Application-Rev 05/2022 < �'4 +'S <br /> m <br /> C N <br /> H C----= <br />