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LAIN USE PERMIT APPLICATION — ��ur i ett County, WI a <br /> 1,4 <br /> Applicant Complete All Sections Below This Line 0 c <br /> Permit Types and Fees:(Please,check appropriate boxes) °' ...t <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 '`*) . O <br /> Accessory Structure(Garage,Shed,etc.) $150._ Addition/Alteration to Accessory Structure $150 \ 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 k` p <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br /> $250 ,,�``7 <br /> XDriveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $3.5b— Boathouse $500 <br /> cn i <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. t- g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 7a <br /> Property Owner's Name: h c . rI L t N fla.. /1 5 t Ai a <br /> Property Owner's Mailing Address: 7 a 7 0 /) 6 a-S S / G vue,/`��' J 1,u4- • <br /> City State _Zip <br /> Loerty Site Address: VT) E= ,S Vg.5h3 0 c <br /> E' <br /> Contact's Telephone Number: C-' / ^ L/ / S I 13 d <br /> Contact's Email: K ? 11 43,--1,t.J4.1:r & Kg gi yyvtp,, ,, - 'v'‘ <br /> 00 <br /> Legal Description of Property: ± l/a 5 5 S /w- �o <br /> Section#: 1 Town#: 39 N Range#: I <br /> t0 W Town of: M eenc'i o <br /> 3. <br /> *Attach additional page if needed for lengthy description OR attach copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement):33) 4 . <br /> Proposed Use of Structur dditi44•.. <br /> r7 <br /> Anticipated Start Date:O --- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY --� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z --C <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 mes,manufactured <br /> home additions, and bunkhou ess..**/S ID , L r _ LAI', t -y i <br /> 1 lui <br /> airleel- <br /> a- .a.essdt S f„ - ,� di�3, I k 1 CC44 CCi r lz, c t4A4-1!,!iq t'✓�. a Fee Rec:�,' `� ' �'� <br /> 6% wet or 1-y- ry(vt.," 'et •f ON � eJudid9, !I/h +- C'Id i9OG b Check#� 4/N� <br /> �/ c 7 <br /> Date of staff site visit: ?fig l a� Initials of s' a visit/a �, P' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> 8/50„) ° <br /> IJP• I� APPROVAL: APPLICANT ► UST" POST COPY OF y m o = 0 <br /> a 5'm <br /> OW <br /> SIGNED 1'ERI IT' APPLICATION IN PLAIN SIGHT o 0 0 Lri <br /> co c N Q <br /> :.< <br /> �� rN <br /> Pagelof5 g1 <br /> Burnett County, WI Land Use App icatio r —Rev 05/2022 .. 3 , <br /> a <br /> 3 <br />