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• LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> b <br /> cn Applicant Complete All Sections Below This Line a OCD N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 V1. Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure ,\O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 - ,�\ <br /> c") v <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ;' X) <br /> Filling/Grading $150 Boathouse $500 n, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 7 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> Property Owner's Name: / 1 y_ r _ .3 �G ! A G a .-.c <br /> Property Owner's Mailing biddress: �b /'cx 6 1) 1 <br /> r_ ' �� p,/� rt State Zip '� �1 <br /> Property Site Address!U� Gam / / /1 �v / 46i.,_ to- ° g, <br /> n <br /> Contact's Telephone Number: 7 5 -,565 11 t7 <br /> IP <br /> 'I r <br /> Contact's Email: e , Q4 4 <br /> 7 0/0 f j7 /77 <br /> � 4zL 'J <br /> _ �U/� <br /> Legal Description of Property: 0-7--oig--(2-57-/e, *-09".,--.0,5 / -"O JItitq o <br /> 0 <br /> Section#: 03 Town#: 31/1IN Range#: /64) W Town of: /9ig-6/0in <br /> a. <br /> n <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/078 -,t' <br /> Proposed Use of Structure/Addition: fii2ia7 1'crt) L:Ct)7.4J6//EbN7/4OEA4 /x' , <br /> Anticipated Start Date: 9 'J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C -3 <br /> Building Contractor: LE6Ac.y/3t}.t,,ock5 Sewer Installer: kx57t/te; sZ)' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r.,4,,�► <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Z \IJ <br /> **The applicant needs to contact their UDC 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 r... <br /> home additions, and bunkhouses.** c <br /> 3 meek- all se4-b� $ <br /> Dviet(ii AA-- 4,,` w o�tee� ; bejX15 Ser SW- 16188 <br /> Fee Rec .J— <br /> IVO aikr In /� a'mo411).1 art-cA- ea.5k cL&eJ4 V • ^3 Check#:�74vS <br /> Date of staff site visit: 6( 3 Initials of site v':' f: L v <br /> m <br /> a <br /> . =CO <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: t/` 1 f <br /> �9a <br /> UPON APPROVAL: APPLICAN. MUST POST COPY OF a n <br /> RI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT : . <br /> 0: a) 0 <br /> o n to <br /> vo <br /> CD C N <br /> Page 1 of 5 N <br /> Burnett County,WI Land Use Application—Rev 05/2022 it <br /> J <br />