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LAND USE PERMIT APPLICATION—Burnett County, WI ac <br /> S .o <br /> Applicant Complete All Sections Below This Line con na <br /> • <br /> a <br /> N <br /> Permit Types and Fees:(Please,chedt appropriate boxes) e1 <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m <br /> C \ <br /> ommercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> �/ S <br /> Jt Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 � <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 2 <br /> /3 ____A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 9 <br /> Filling/Grading $150 Boathouse $500 0. <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> *NOTE:After-the-fact permits(permit aquired 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 g <br /> *items not fisted above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: /'t/e(y /� rvlS / glG/1trCt HJ e//m i j ro <br /> � , <br /> Property Owner's Mailing Address: [ D 3 5774 S/ ���1-47-17 /'/� n ` :06 ° 4 <br /> 116 <br /> City /' ' State Zip < <br /> Property Site Address: oZcs1// Slt/t 4/1 t I j 'J Z'A I I Gi -A" 464..1(ref j (tet.'/ 5'pa 4'/y '� _ <br /> Contact's Telephone Number: �4Q ,;./8'01 5/9 7 ( 7,43 3,70 0347 d <br /> Contact's Email: r1 Ch j 1/m /►i/ e0 h0%ir►WI <br /> I\ /, 4_0irl N <br /> IP <br /> Legal Description of Property: j.0 5O GS Sa 14,/�( , got° <br /> Y. <br /> q / f 1 <br /> Section#: ),'7 Town#: 3 ! N Range#: / 9 W Town of: (�,itaj 1 /?l&r�/ail A <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> co <br /> Tax ID#(1-5 digit number;found on tax statement): 3 5'b'IC x <br /> Proposed Use of Structure/Addition: ,)Ic,le a. F t; <br /> Anticipated <br /> -` <br /> Anticipated Start Date: 1,2S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -3 w <br /> Building Contractor: 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 /> xi <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,manufacturedr ,� <br /> home additions,and bunkhouses.*7 C.-)tvr <br /> be "i i COt7.T„+<:61DTee+ J,1( 5e-f-b�c,�i, ` 1 G A l r• /5-7,34 <br /> � 4 <br /> p1- ft,' '(µ,/MAA kq.bt a. 1C1'� ( Fee Rec: L i)l)— <br /> tr aeels CAI;1t �(.41:f I . Gt i/ pee ct ia..l_ 30 44•J t , Check#:LOLL P " ' � � •^ A (/ rn <br /> Date of staff site visit: 7( /?'p" Initials of site visit s ,ff: a r <br /> APPROVED BY LAND SERVICES OFFICIAL: I" DATE7/)7/?.? r ^ <br /> UPON APPROVAL: APPLICA MUST POST COPY OF @ ;2 z . 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 o Q <br /> o 0 C <br /> Page 1 of 5 n •` N <br /> Burnett County,WI Land Use Application—Rev 05/2022 m 0 1111 <br /> J, <br />