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r <br /> LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 6 a N <br /> Permit Types and Fees:(Please,check appropriate boxes) da <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 fP. ''\1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining WaII/Sidewalk Bunkhouse $250 SI <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 (1.1‘' <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 o. <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. � <br /> 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> p <br /> 1 � 1 ' - 'rf <br /> Property Owner's Name: 0 D ^^L, t i 69(0 ` e ro. <br /> 1 <br /> Property Owner's Mailing Address: cAe 0 ( 63,,,,,, , PQ / _ssfj , <br /> n <br /> . � <br /> 2 _ � . . . Stat- Zip <br /> Property YSite Address: // 1 e ri ��� <br /> _ <br /> 0. <br /> Contact's Telephone Number: rj- 2, 1 . 0 Dl <br /> o <br /> Contact's Email: SGL I ' ek w _.7 i, . t ' �'L-JN b <br /> f 'r <br /> Legal Description of Property: ST r+ 10,:,_e LA)' f �� l a. )6 0 *l I ap <br /> d <br /> Section#: Town#: N Range#: W Town of: .{t 4. <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '" <br /> Tax ID#(1-5 digit number;found on tax statement): 1 9 1 ` o <br /> ii1 / <br /> Proposed Use of Structure/A 'tion: -^' ,4$; Gn ;l .,d iid&A to t7 <br /> Anticipated Start Date: '7 cf 7.4., (Home/C'afiin;Comme fiat Business;Beck,im;Dir etc.) • i ` v.i <br /> i <br /> Building Contractor: B wt, Z Qbew'er Installer: A_9/A <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 Po <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.*,* <br /> 1\)9i9i Q-0( , <br /> ( 4.441040 l�bl i` vn <br /> a- gid? Sh ,ea5 e (11°L' c "\-D '- �lihij''cAcir. _ Fee Rec:5w pr e'AviC' 4,6l0�' 'f 4t+.S q,He1�fiUr1 /l ci Check#: 7/057 <br /> 711 q IL <br /> Date of staff site visit: � Initials of ite visits ,5/i <br /> I/kr � <br /> APPROVED BY LAND SERVICES OFFICIAL: /OilDATE:g/5 s <br /> n c.._ mi <br /> UPON APPROVAL: APPLICANT UST POST COPY OF '4._ rq 0 <br /> s O1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT V o -_ <br /> r17 5 N <br /> N <br /> 11-/.1•Z <br /> Pagelof5 '" <br /> 511 <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> c �� J <br /> a <br /> b <br />