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LAND USE PERMIT APPLICATION- Burnett County, WI a <br /> 4.2 N <br /> Applicant Complete All Sections Below This Line 5' CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) ;; °d <br /> �^. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 pp 1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 pn <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining &all/Sidewalk <br /> / ` Bunkhouse $250 ° u <br /> 16> <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> -F: C ' <br /> Filling/Grading $150 Boathouse $500 <br /> r <br /> m <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2 r- <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. CD V <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. "" Z <br /> l/ I <br /> Property Owner's Name: ( en U o// �� � 'cop to /7 $ <br /> Property Owner's Mailing Address: //D O g/ca I,/ 2lLrfrj / c. _/J O617er, n <br /> / // City /i State Zi i c - v <br /> Property Site Address: 0 / I - 1 ,,4 I _ -I/ /Ye K/ a I 7 ' <br /> 'g ! <br /> Contact's Telephone Number: 6 5-r/ - 4/5y-..._q//( , d <br /> Contact's Email: k'/' /kc(QJ yQhQO , aDi/I N -0 i <br /> o cm <br /> Legal Description of Property: � d5 437", 71, /� r- <br /> Section#: 3&2 Town#: --=' N Range#:�h1 74'2y W Town of: Qp ��$ <br /> *Attach additional page if needed for lengthy description OR attach aacccoppyy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 7 O O / <br /> Proposed Use of Structure/Addition: t_ Q 4 t qq a) j/ d <br /> Anticipated Start Date: -,,,140, (H Cabin;Commercial Business;Bedroom;Deck;etc.) ^3 - M� <br /> Building Contractor:ClGQ, i( i i-.� Sewer Installer: d!'. •_ 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> x <br /> "*The apps€ awwi neCii. 10 ,:oriftict their DC Inspector"to determine 1/it pernnt is needed from then prior to <br /> .3:AY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> - 04 I e)c -�,• ,t}u:II; t t(5 +2 be ,re f l aced( / <br /> tym�ar w c., c :e C C)G's1'�1 r €III Iraq irS fl' f Wo+ Fee Rec:/�5Check#: 53 fl-- <br /> ONl. ok4 r�e�o�al. a <br /> ---rnr 5 dorm 10)1 -Pe- <br /> w,-Ica- n eer� a s � � o <br /> Date o staff site visit: e/v?. Initials of site visit staff: m <br /> BY LANDSERVICES <br /> O FICCIAL:� I ,� _,. -j. / <br /> APPROVEDr" DATE: 8/8/20) Q <br /> UPON APPROVAL: APPLICANT UST POST COPY OF a ` lit li <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT § ,, <br /> 0 <br /> N 0 v <br /> o r= <br /> Page l of 5 8 S, <br /> Burnett County, WI Land Use Application—Rev 05/2022 . =. N <br /> L ->J <br />