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A- SCE ATr tc..lt \ 0 2161,t'- L poop go j ik- PL-4 vk"R 0r,,3 <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a r <br /> , • b <br /> Applicant Complete All Sections Below This Line $0N <br /> Permit Types and Fees:(Please,check appropriate boxes) a an <br /> ^ <br /> C:) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200l ` , <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 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> CDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/ &Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> ,\()C) <br /> � <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 X Permit Extension(1 Year Extension-Allowed Once) $100 F. <br /> q <br /> *NOTE:After-the-fact permits (permit aqui red after construction has begun)may cost up to three times the normal fee. - ,1n <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. o <br /> Property Owner's Name: N A- E j 1 0\ 0 E 1r R-k(AA 2. <br /> Property Owner's Mailing Address: t%50 3 \ 3RD C—t r -e NAL,„) EU (2kLE e trtirJ SS 3 =' <br /> City State Zip <br /> Property Site Address: _7 of So u.T - Dei ILS t kt E pg,(J>✓ , I,J cos 1 i i.J 1 . SI-1 err 3 F. i <br /> Contact's Telephone Number: to 1 2--9 b`{—b°I`i 4 d <br /> Contact's Email: 12-e D L E&-f 1 . AA # L!326,41-1 <br /> *sez A1TA c t vo <br /> Legal Description of Property: 5Ec- c.5 Tv, 39 RI_ 1 1p Lt 3 L S t V 2_5' Pio 3(4 L ) tio <br /> d <br /> Section#: 3 Town#: 39 N Range#: I to W Town of: VI E3 STEYL 'M 1._%.t.i•-- 7 <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`1 0-1 S <br /> Proposed Use of Structure/Addition: CA IS(c`1 •''� d <br /> Anticipated Start Date: 1\4311-2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-3 <br /> Building Contractor: De?.-1.c\ 0 o r l S"i"i2u T s CJ Sewer Installer: EX1,5 j 1 IvC% ps Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Q <br /> **The applicant needs to contact their LDC 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 bunkhouses.** <br /> 2(Vle&-�--J Se c I� <br /> Fee Rec: IOC' <br /> a Check#: <br /> Date of staff site visit: /1121 AInitials f site v' i t- <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE:t(',[pa <br /> , , <br /> c <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF ta <br /> D <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a 2 <br /> g <br /> ge <br /> N <br /> Page 1 of 5 'P o <br /> Burnett County, WI Land Use Application—Rev 05/2022 < : "' ff <br /> m <br /> d <br />