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. LAND USE PERMIT APPLICATION — Burnett County, WI a _ <br /> N <br /> tn• Applicant Complete All Sections Below This Line 0 CD <br /> N <br /> Q. <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "V <br /> F <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 b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> R <br /> l' <br /> *NOTE:After-the-fact permits (permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. Z' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o• 10 <br /> Property Owner's Name: DO C0011,1 MV0 ce/ n. <br /> Property Owner's Mailing Address: (5$ger E h,,f?� Lint ig1 t3 pop(.V 11{9 MA/ s.S/ay - v, <br /> (31 i 3 City / State Zip <br /> Property Site Address: 703 Z �new�d ( ` a, <br /> Contact's Telephone Number: bs 1 ' 503. 8Ssct `" d <br /> n�e. vv) <br /> Contact's Email: 4 ; Co/25 1:k4-\e.e L 1/010°. N <br /> Legal Description of Property: LP,- 3 C5/44 U. 2-9 /. 52- R. \� <br /> ti. 1 <br /> Section#: 33 Town#: 39 N Range#: ((,p W Town of: / ieer'pr n1 <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(:::, <br /> O( 0 To \ ' ' <br /> Proposed Use of Structure/Addition: Pi-CC. c - -t i'LgG- 2q x 36 ? W a d <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 ^3 <br /> NBuilding Contractor: Sewer Installer: w6 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY -...Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z o 4 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to '`i <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes, manufactured <br /> home additions, /and bunkhouses.** / <br /> 10 NOT /v h use -ice vt 11 wl4 M /f�14 4/•A:04o n • <br /> © kelt- ex - - 1.0 y " "ei✓"/ z Fee Rec: L504' <br /> Check#: CCa.-,VN <br /> v <br /> Date of staff site visit: g/9/ .49 Z V Initials of site visit staff: JA, /, m <br /> � 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: z <br /> DATE: JD/?,OtZ * m <br /> ff <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g 3 o. 4.... <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c o G <br /> Pagelof5 x3 <br /> Burnett County, WI Land Use Application—Rev 05/2022 < " ` <br /> C L .J <br /> C <br /> N <br /> a <br /> 3 <br />