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-- LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> __ Applicant Complete All Sections Below This Line ° cn CD N <br /> Permit Types and Fees:(Please,check appropriate boxes); r d <br /> Dwelling/Principal Structure $300 .'—Addition/Alteration to Dwelling/Principal Structure $200 Fr <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 o r• <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g <br /> Filling/Grading $150 Boathouse $500 c <br /> AD qv <br /> Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. CD qb <br /> 1 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> li <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name:CE)L ) S ck b6' <br /> Property Owner's Mailing Address:PO ASO k ' ,�1` .V j �t `-�14�0 <br /> ` City ` State Zip o <br /> Property Site Address: 4Ni-2,1,-ch Sit- --I7 .�l �` • <br /> a <br /> 1 _ 1 a <br /> Contact's Telephone Number: j 1 CI I CI — 3 d <br /> Contact's EmaiL•QD L MA I J E 9 a 6 t "l A 1 L 3 C,00-N LA, ? N `° <br /> Legal Description of Property:LAlt.k-' i 1ryt 90‘41 OOlptn o(t i imch 1 (4/V/ ) 1-106001 d <br /> Section#:. 1�Town#: ii(t N Range#: \ki) W Town of: 'ro 4 CotiL A*r \) 3. <br /> *Attach additional page if needed or lengthy description O attach a copy of the deed OR attach tax system property page.* <br /> rn <br /> Tax ID#(1-5 digit number; found on tax statement): '1C.131 --. o <br /> Proposed Use of Structure/Addition: Orfl€. l , V\ <br /> Anticipated Start Date: t iF)l 'aD9g (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O Is 1 <br /> Building Contractor: \ /ly-> S c,t.,t,L rti;-- L-, Sewer Installer: c i.r)sz .,Lk t r C;),I c <br /> AireAkk i Q.Jci nth 0 .M• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY i z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 'S <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** I I _Lr i <br /> 6 c.a. (s ID b e. Ciwml by G/i/z 2-3 #v a cil U ST /414,171- <br /> �,ate <br /> boll t�[ it //OGa�Oik, r t L / L x Fee Rec: <br /> /t/e) celAc. . Cif!o p1 tiq f til /JL'. 75 /Q/ . l! f74 Gam—• y Check#: <br /> v <br /> Date of staff site visit: 6/ y'zoZ.Z- Initials of site visit staff: /rAPPROVED BY LAND SERVICES OFFICIAL: �r+ / <br /> DATE: a � O Z'Z' <br /> ✓' r- <br /> Tr <br /> UPON APPROVAL: APP CANT MUST POST COPY OF W zem <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N C) o <br /> • CO <br /> 0 f/faAVla/s aA4 /ahoy hof- lD exc. i lo, goo per <br /> PaeAAAct g f5h. <br /> '` ^ -< <br /> Burnett County, WI Land Use Application-Rev 12/2021 . ; . <br /> Jj <br /> 0 <br />