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LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line o N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ....,_,„, 1\ <br /> O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 U\ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C') g) i) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 )" <br /> Filling/Grading $150 Boathouse $500 - 0 <br /> v) <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. n 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> / 'ET \� <br /> Property Owner's Name: / d ' 47 /,u .•22 b <br /> Property Owner's Mailing Address: 3)1 W i a-Se , C 6 �g4Ati/ V k-& p'-y3oFc € • <br /> City State Zip < <br /> Property Site Address: (,f' 1'V\ e <br /> CCa <br /> Contact's Telephone Number: 7Nd <br /> co <br /> Contact's Email: digijiej 3 e Fe 46 is ® IM q 1 L Com oN 00 <br /> Legal Description of Property: 1 �;m 1'( Q3 o <br /> d <br /> Section#: "5 Town#: s--/I N Range#: 1 '5. W Town of: �w I <br /> 5. <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): 3' i'1" - o <br /> Proposed Use of Structure/A rtio Ca(` C <br /> Anticipated Start Date: ©8/d 1 I go\ 1 (Home/Cabin;Commercial Business;Bedroom; eck;etc.) - vf. W <br /> Building Contractor: /L// (((�1&) 0(,f C p C 4� Sewer Installer: �1� ��i i * , C�1 <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 additions, and bunkhouse .** <br /> ) eet- 11ik <br /> yh <br /> ga 4.( f ,1cj 't"' iti -- Fee Rec: ?/6-06° <br /> ,�—, Check#: 1:i-Sh., <br /> Date of staff site visit: 7/?5/201- <br /> Initials of s'te visit staff),4 � <br /> APPROVED BY LAND SERVICES OFFICIAL: /ii. DATE: x, l� <br /> UPON APPROVAL: APPLICANTUST POST COPY OF cFia jj <br /> r- 0 <br /> <. <br /> >6 CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT �o o <br /> -` N <br /> Page Iof5 53 <br /> Ifthi <br /> Burnett County, WI Land Use Application—Rev 05/2022 ;' - <br /> c L J <br /> V <br /> > <br /> x <br />