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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> 4 Applicant Complete All Sections Below This Line cCD a <br /> rermit Types and Fees:(Please,check appropriate boxes) ! a <br /> 11-- \ d <br /> ' x Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \`J <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 . <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures - $125 WI State Statute 59.692(1v)Structures $350 '' t) <br /> c <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 squired after construction has begun)may cost up to three times the normal fee. .0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> : is._ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> Property Owner's Name ,. <br /> : • c���.'(\1\ c Ic.k g <br /> b <br /> e Owner's MailingAddress: a z ->C <br /> Property 34Q3 �u��.o.cc� \..q\`� �a • 5;��r� WS SN�"1 a " ' .-M- <br /> City State Zip C <br /> Property Site Address: 5 a, o_. ° c <br /> 0. <br /> .. <br /> Contact's Telephone Number:'\\ '"\'"\c043% ^ 5" O\ o <br /> Contact's EmaiN'.c�� 0.=V.yNO 3c,3 0�. C, -•Civa•\ • C._,_syclN N <br /> 0ro0 <br /> Legal Description of Property:G 0\1-- \.,• •-`c 3 - El.' Q CA-5 A. <br /> Section#: a% Town#: 3 I) N Range#: \-\ W Town of: Q a, .‘ dN <br /> 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): abs C\ <br /> Proposed Use of Structure/Addition: S,,j q,\\\i d <br /> Anticipated Start Dater, -a",•'n (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> 93 <br /> Building Contractor: S Q„\- Sewer Installer:'"'C: .\\\o f ; (S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY R --a <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 zi <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses. <br /> ale e4- ill 5e-M c <br /> OVAR', rte, -b w zee, ; b4roortpee54'" -p?-1144,45 <br /> Fee Rec:()le. �1, 3 - 4ni y Check#: <br /> o <br /> Date of staff site visit: Initials of site visit staff: m <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: _,,a..... _ - DATE: m r ' " <br /> — a50 <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF y co c G 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Zoo ''; <br /> r w r ��1 <br /> Page 1 of 5 `" M <br /> Burnett County,WI Land Use Application-Rev 05/2022 <br /> o <br /> v, <br /> -I <br /> a <br /> 3 <br /> .. <br />