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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 U1 <br /> V Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n �) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 (V n <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: <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> , <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> ' � H 1 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. W ►w <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. <br /> *) <br /> Property Owner's Name: M,I ke Pc4 Vl pt-v /,5' g-7 J a 1" <br /> / � -0 N f <br /> Property Owner's Mailing Address: /b0/ 7,-e r h e y iU vi c e>?, w� 7 <br /> J ___city State Zip c <br /> Property Site Address: 2U `>/a G We 51 Sr-/-IP � �/ Ntyi� S(10/ . N <br /> / n ,f <br /> Contact's Telephone Number: L i'$6( f c?fri Uc 3 4. OQ d <br /> Contact's Email: ilk ipetrtd�C�cv56 ,74S,vie v\ <br /> go <br /> Legal Description of Property: lOS 0`1 .1142�if���� //�• �1#7v til <br /> / d WD <br /> Section#: // Town#: `t N Range#: / W Town of: �C `,� (N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> " \ <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): 3s-,iSg C! H P <br /> Proposed Use of Structure/Ad�'tion: ,6(�7/Xa e- e <br /> y <br /> Anticipated Start Date: (// 9/i20 Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 -3 <br /> Building Contractor: reiA)Jot',✓►S cii Sewer Installer: 13,1,-K-11 p1L,.rn b;v2q W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 �' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured ..., <br /> home additions,and bunkhouses.** / <br /> r✓1Utf' fay /,4sGtMe � 7'P <br /> k1 '&& of e-x,s74Ny 5 ��. I <br /> IN0 f' ir. GXCn tc/ A A::::44.71- ee 3S— t'r.�/ ' Fee Rec: 50 f�Co K�a cif U G -.14S?e N (Se I^ 7s4 e4'A"p e,/ !N►/717 c, Check#: 3 k31::,8 <br /> 6 <br /> Date of staff site visit: V2-1/ O Zc, Initials of site visit staff: / '/ r <br /> APPROVED BY LAND SERVICES OFFICIAL: - DATE: 09/2.0 ZZ— , glm <br /> < Tr <br /> 9 <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF 6 , <br /> y coO r <br /> USIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o0 <br /> c <br /> "< w,< r:s <br /> Page l of 5CZ f <br /> Burnett County, WI Land Use Application —Rev 05/2022 - - <br /> J <br /> a <br />