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LAND USE PERMIT APPLICATION - Burnett County, WI a 2 r <br /> b <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) ,- <br /> 0\ <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200t �, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v00 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> VAccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $1005 <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. ' @ •l% <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. oz 1 <br /> �) i V <br /> Property Owner's Name: r C'- 1413Cilt S no. <br /> Property Owner's Mailing Address: _g 1 7q 4(1,100-p^ Or L.& ry tar -5" /34, i r) <br /> City / State Zip <br /> Property Site Address: - i7q • <br /> CD <br /> 0. <br /> Contact's Telephone Number: ..3.1g ,,. 34'1 -- 5-414"6* o <br /> n <br /> .. <br /> Contact's Email: , . A _ 4 7 , 1 .r _ o <br /> Legal Description of Property: ,L CcgM �I�i(� 0 <br /> /� d <br /> o0 <br /> Section#: 4 Town#:lib N Range#: Ll W Town of: U fx.10r, 3 <br /> r) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> v) <br /> Tax ID#(1-5 digit number;found on tax statement): 0,267._32... 7 o <br /> x <br /> Proposed Use of Structure/Addition: . 5 <br /> Anticipated Start Date:_3 co _ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —I <br /> Building Contractor: 6_,1-F- Sewer Installer: Q. <br /> O W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> pv <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 J <br /> home additions, and bunkhouses.** <br /> 1 ►Meer ,,,II sc 4..0-5, <br /> N�- �r ku✓rZKfi n"y,r�1�� _i Fee Rec: <br /> 1„4. .u�, ►Its Oi — 304 , , livve�%/ I l - S ,�- Check#: <br /> g/V/�� ° <br /> Date of staff site visit: Initials o site visi j � rn <br /> APPROVED BY LAND SERVICES OFFICIAL: '., �/, ,-4.- DATE: /.30!a� �--1 <br /> UPON APPROVAL: APPLIC ' MUST POST COPY OF '-' <br /> < 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 0o 0 <br /> CD C <br /> Page 1of5 3` t <br /> Burnett County, WI Land Use Application—Rev 05/2022 �U <br /> LTJ <br /> x <br /> , <br />