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LAND USE PERMIT APPLICATION — Burnett Count, WI cr <br /> Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees:(Please,check appropria< b es a <br /> Dwelling/Principal Structure ( $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a .\ "n <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r + <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <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. o 3 ^ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. . 1 ' 1 <br /> o <br /> - 1 1/4 <br /> Property Owner's Name: .101,1Ala6 ^ SHELL—IC -3-AcossP.L. <br /> , , <br /> Property Owner's Mailing Address: IN/ FIA/4 �MEp5 T 5:162.5 <br /> WI- <br /> n <br /> 4o <br /> Oce <br /> City State ZipC 'c <br /> Property Site Address: 2483/ Wilt-SER(, Ri�, Sleek), t.xc 541372- -• R 0 <br /> Contact's Telephone Number: 1(5-3 $ <br /> 3 - Z9 33 ` o , <br /> • <br /> Contact's Email: JACo6S.eit..ayne (e qMq�1. co" N ro g' <br /> J o ao <br /> Legal Description of Property: N 112 N 112 5tn1 114 5E 5e <br /> - c <br /> Section#: 35 Town#: 39 N Range#: 16 W Town of: MEENO N <br /> *Attach additional page if needed jbr 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 Z S5O P_\ o i <br /> /� W x <br /> Proposed Use of Structure/Addition: l7/NtAC�G/ Gq,f3� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Sal7-2 ;� <br /> Building Contractor: 10 p/tat� p ( /CgnS�i Sewer Installer: tM / W `N� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY "1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z p <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to c) <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> D ,4ny -1 i Iec' //s w, Nexx / bee /uce ,pae,,,,nt'7z'. <br /> No L G <br /> eXC-e b okos ,,O€ SAA./ <br /> ,, Fee Rec: Soo <br /> C s <br /> dpe,€1-- Ca 5 l^Q • Check#:70, <br /> Date of staff site visit: , Z Ini '. of site visit staff: 0", 7— 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DA : C1772A9 a Z :.r <br /> MI <br /> UPON APPROVAL: APP CANT MUST POST COPY OF W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,0� 0 <br /> 0 o p <br /> 9"..3 <br /> • p- <br /> Pagelof5 -` r"v' <br /> Burnett County, WI Land Use Application—Rev 12/2021 2 r <br />