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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 G N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> )(Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 S '<. <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 6 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °.. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i. )3 Ilk <br /> Filling/Grading $150 Boathouse $500 v, ' <br /> A <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> q <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. co <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. E =•(A <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o 1 4N <br /> E. 1 <br /> Property Owner's Name: viDi A m gSlg,kpvs a <br /> 5 n <br /> Property Owner's Mailing Address: 30x:7 a t\ Art N PAN y W% stets E - ` <br /> City State Zip < - kh <br /> Property Site Address:B S C IMOY Ft DAN15u(Ly VII slima :, . gr <br /> Contact's Telephone Number: -As_7 on— X13"1 b g <br /> Contact's Email: L9.WIL Q ("omit- COM ,� <br /> Legal Description of Property:g A1tP oft Apoo lc qua SW frq <br /> Section#: IA Town#: 1.1() N Range#: 11 W Town of: V N 101 <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):) 3bOb/ <br /> ow <br /> Proposed Use of Structure/Addition: Ii p <br /> Anticipated Start Date:Iut.v 1 i at0a3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: INDIA mem pis Sewer Installer: Q' <br /> ,S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <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,rand bunkhot ses.** I. <br /> 0 tr eeT a l` 5e- ekt ISS <br /> ),/e1113 e&F exce3 bed rePeot5 pe( 5*-2? -/.5.6 <br /> Date of staff site visit: LI /2-6/w-pl Initials o site visi .t- CLI Fee Rec:}13OO <br /> // � Check#: �COS BY LAND SERVICES OFFICIAL: - / / DATE: 7/? /? P <br /> UPON APPROVAL: APPLICAN UST POST COPY OF u, <br /> a aC <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , 0,F, N <br /> Page l of 5 P o I f, 7 <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> H <br /> .z N C <br />