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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a .0 r <br /> V <br /> ,, Applicant Complete All Sections Below This Line o• i i <br /> Permit Types and Fees:(Please,check appropriate boxes) ° ct <br /> Dwelling/Principal Structure _$300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 00 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalkunkhouse $250 ° <br /> Driveways/&Campground Structures $125 Ii5Wl State Statute 59.692(1v)Structures 4'� c, ,$s>r' o N <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100E. <br /> *NOTE:After-the-fact permits (permit aqui red after construction has begun)may cost up to three times the normal fee. ',t iN--- <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 9. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> .11 <br /> Property Owner's Name: /9 ��e•/` i 57-'d ' 24. 0 <br /> Property Owner's Mailing Address: To /d' L. %, $'7 ( W� 9iii7 'I 2 <br /> / ?Be? ��p State Zip �� <br /> Property Site Address: 6?B 5. 17z-v-r—.S 4.47ti erre, 51 'T7 ° G <br /> p 7/s'�aa_5� �, <br /> 5- <br /> Contact's Telephone Number: � � d .L <br /> Contact's Email: %�-=zie.- 74/104--,'72 6/99/ L .t✓0/77 N ,I:, <br /> Legal Description of Property: 3.4-6---A7 ,e-P I <br /> Section#: Town#: 3 7 N Range#: /6 W Town of: Ne€4 011. N <br /> a. <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): I i ), ? j `, _` H <br /> Proposed Use of Structure/Addition: G'a C 7 _ ' h/<JJ,T ./e- <br /> Antic;g64ed_S_t Date:/'Y#¢Y(p. 10 (Home/Cabin;Commercial Busines Bedroom;Deck;etc.) 1 H t_ <br /> Building Contractor: Sewer Installer: --__ <br /> ..\...S •••• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z o -J <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to p:' <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes,manufactured 1....€,z <br /> ome additions,and bunkho ses.** a / f� ,meq /gyp • <br /> nil z00 /s USC4 1Cr .� /tV? v) p YC VIlitON . <br /> © M N S i' Fee Rec:Q14,14) p vg_s este va mpt a9 v e 44 e.-tei ' sec.c&* Y77.5.75• Fee O <br /> O 11 11__ <br /> 3 NGtd 1Oc4 Gi <br /> a a1N ~oSc.fhL mit. - / O//?•O ZZ. y Check#: 74o27 <br /> y <br /> q O <br /> Date of staff site visit: : / W Ze— Initials of site visit staff: t A m <br /> 2/0111"7-- <br /> q <br /> APPROVED BY LAND SERVICES OFFICIAL: �� DATE: O / �LZ <br /> v. ��_J <br /> Pv <br /> Ifilil <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF n `c 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT :Trte= -- Grin <br /> z °' A —* <br /> r me o <br /> N <br /> Page 1 of 5 7, op, N <br /> Burnett County,WI Land Use Application—Rev 05/2022 2 [jili <br /> rn - <br /> a <br /> rA <br /> LL —J) <br /> i <br />