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LAND USE PERMIT APPLICATION- Burnett County, WI g b <br /> s. y <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 .. <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 <br /> I t R; <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e- 0 (1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> ___$olar earl. ll, (5Iand a(_on (1 <br /> r f mounted) $150 Permit Extension year Extension-Allowed Once) $101 =. <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. ' R. ('6 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. '" Z c' ' <br /> Property Owner's Name: �('� j -�l l til / 1)(..-(VA6. o <br /> 0. <br /> Property Owner's Mailing Address: / 'J q4? �`' S T' iii r'"c)I r ` ..ii C4 <br /> �,(!� City State Zip t N <br /> Property Site Address: 2g ! (� 1J oma- 1�iv.(62.... (?. (� . o �, <br /> Contact's Telephone Number: S7-, ?_....0 'Co 3 66 E) <br /> ts -2,,c' P:, <br /> Contact's Email: $e--;;;11-3 L kto,+(L_'5 1 3 8 Wi.c ;( , C 0 to-A. <br /> NV <br /> 0 uo <br /> S. <br /> Legal Description of Property: 00 <br /> Section#: 1 7 Town#: L/O N Range#: /7 W Town of: 0i'l 1O Aird <br /> 3. <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 /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): 2.418 63 <br /> Proposed Use of Structure/Addition: S k\ / o <br /> Anticipated Start Date: •�.J u.l)/ 5 2,I (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) '-1 CO <br /> '� 1 Building Contractor: S i,,,40 c.1 ,--'• ‘c:7. -��� k �� Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 additiond�bunkhouse . *c� /' ' t ,��,.,� <br /> iMe'r/i- <br /> 4/ ha' rd - 1 CAO St r '�. ,3 51144-"""' <br /> War�r /Iv-MAO h y Fee Rec: _Q pS, <br /> re <br /> 4444441`0 4 ' � deep Lar tls�'& ?e-(A4" yp7/ isp�- �, Check# : /j0-Date of staff sitevisit: 7 ,4 l v I>�itials a site nisi ,to ,i er <br /> r <br /> ` CO <br /> i� z <br /> APPROVED BY LAND SERVICES OFFICIAL: ,WL, /...‘,...-„.:-...jr..-- DATE: 7/X2/0%) 0 7-1 r <br /> UPON APPROVAL: APPLICA MUST POST COPY OF U C 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT s o <br /> Pagelof5 t <br /> NJ <br /> iiiiii <br /> Burnett County, WI Land Use Application—Rev 05/2022 r' - <br />