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• LAND USE PERMIT APPLICATION — +'urnett Cou ii tv, WI c <br /> N , <br /> Applicant Complete All Sections Below This Line 0 c N <br /> Permit Types and Fees:(Please,check appropriate boxes) , <br /> Ci <br /> Dwelling/Principal Structure $300, Addition/Alteration to Dwelling/Principal Structure $200 ,,` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200DO <br /> VVVV Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 t, ,'\. <br /> 51 <br /> Accessory Structure(Commercial/Industrial) $200, Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> 3_ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 �l �r <br /> Filling/Grading $150 Boathouse $500 /_ sh <br /> w ,- <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 co <br /> 4 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. CD <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. a <br /> Property Owner's Name: <br /> lllIe , 4 Lit-)414 . C1 ! t .) �, <br /> 1 —7 - Wooly glr b <br /> Property Owner's Mailing Address: 01 i T tir 7 , /4 G s r "6 Aid ol .. n <br /> j) C'ty State ip <br /> Property Site Address: 71-i6 -76 ZECI-10)1114 t ) . ' WI 'Slit-30 . . °— P - <br /> Contact's Telephone Number: (95-1 ' 2-7 ^ /C7.— I CL pp <br /> d ( - <br /> ' t A <br /> r <br /> Contact's Email: L"'FD M 11a L e ,it4rtl 1, (VA o n <br /> Legal Description of Property:))CeY" f n: dt- Aii 6 t lme{ 01 ll�]�/, lo P/� E.E lis <br /> Section#: tj Town#: 0 N Range#: 12-1c- W Town of:�kLk,sei -) <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): Ui deD - o <br /> ry �� <br /> Proposed Use of Structure/ ddit' n: b& �� d <br /> Anticipated Start Date: 9 l r S(�1— (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) --3 <br /> Building Contractor: c Sewer Installer: I.) (A , �V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Aj W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 0 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to Po ). <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouse ** <br /> P ee I- a(1 sG 1�4 tJji ‘ �� <br /> 0 42( K�t4 rof k6b'1 4 " " Fee Rec`/5 <br /> Check#: a/S.-- <br /> Date of staff site visit: 7/?(Q/ 0 <br /> // 9-a Initials f site v s Z <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: / t ATE: s_.. -, <br /> UP S I� APPROVAL: APPLICAN-- , MUST POST C I�PY OF 7.3 <br /> W r . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> ry Q <br /> Page 1 of 5i 511 <br /> Burnett County, WI Land Use Application— l':ev 05/2022 < (; ` <br /> o J <br /> a <br /> I�o <br />