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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line o N <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Fo <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 [1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 X 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. C <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> 0 IP <br /> Property Owner's Name: 13ur-1- -f- i-01/1/1e Kers-I-. <br /> P Pr" n \ <br /> �� S'+YN3 <br /> Property Owner's Mailing Address: 62 /S Sc 11a',i diet- RG, Web -kr W.—' 5' n <br /> tt If City State Zip <br /> S4 c' E ; <br /> Property Site Address: {\ <br /> V • E. <br /> Contact's Telephone Number: 6.S/ — 2-53 0 yZ Id <br /> w <br /> rD <br /> Contact's Email: C <br /> b Ke�s�--�e��� ® o�n�u;� (lin N <br /> Legal Description of Property: v <br /> i <br /> Section#: Z 3 Town#: 4 U l N Range#: b W Town of: al/0y, bN <br /> 5'. <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 /> , <br /> Tax ID#(1-5 digit number;found on tax statement): l 3 S 3 + o <br /> Proposed Use of Structure/Addition: 6 u r vii{ ' <br /> Anticipated Start Date:1— S-2Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z J <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,manufactured <br /> home additions, and bunkhou es.** 0 CCh a 16 / <br /> ree-4- J .SG a 4 C 7�T T1+t' `►d <br /> -£p( h AA Iii1Rfiyr Fee Rec:PR.�-TIS �4:�) r '1t' <br /> t, Check#:C 37 <br /> 742-0/??--, <br /> J lj v <br /> Date of staff site visit: `� Initials f site vis' staf m <br /> — a <br /> .. /4iP' z <br /> u <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: e16rn J <br /> r— <br /> UPON APPROVAL: APPLIC • 7/MUST POST COPY OF co. <br /> a m e r- <br /> -r CW <br /> Z. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT u0Ifiiil <br /> { cri <br /> -8g N-) <br /> Page l of 5 x °' N Q <br /> Burnett County, WI Land Use Application—Rev 05/2022 : 2 <br />