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• <br /> .. LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> Applicant Complete All Sections Below This Line F ii <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> Dwelling/Principal Structure $300 'Addition/Alteration to Dwelling/Principal Structure $200 <br /> 7c,Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> C <br /> Accessory Structure(Garage,Shed,etc.) $150 to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r. <br /> "•-• <br /> C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 - p 3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c rQ`J <br /> Filling/Grading $150 Boathouse $500 lv <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 d <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. c J <br /> *Items not listed above will be treated as accessory structures,u�such as:pergolas,1landscaping,etc. "' z <br /> Property Owner's Name: -Seta t "t' 1-)0..\e, I' 0. % L-1 ��(\ a <br /> Property Owner's Mailing Address: 1 OA,I SY le(N CCC(C GYM/Q. Th 3 _ cp <br /> Property Site Address: 1181 Go 3o Cnd) nbuy t.1\ CityStat SSc Zip <br /> .p c <br /> Contact's Telephone Number: 95Z '.331-1—L4014 5L/SO. o �° <br /> a <br /> Contact's Email: JG`ME <br /> � ..C�reS wo`�N G� (Ac .)fNGp • Cc v\r\ v <br /> vv IP <br /> o va 0 <br /> 0 <br /> Legal Description of Property: o <br /> Section#: 1 I Town#: 4C) N Range#: LA W Town of: <br /> ' ar\Coti:ik <br /> E. <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): '-1 C,C' —' y <br /> /�� I` ` X <br /> Proposed Use of Structure/Addition: 'C Qq e. o <br /> Anticipated Start Date: coo.\\ x7-7.... (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) H <br /> Building Contractor: Cl!„h- Cu.cveVe Sewer Installer: ru i A •� <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 frontes,manufactured <br /> home additions,and bunkhouses.** <br /> S 141Ai <br /> I- 01 5444 jis <br /> •�' t/YIA h IAA 0,4.14;0 <br /> y Fee Rec: /3 a� <br /> Check#:652,3 <br /> g16�2-� _ <br /> Date of staff site visit: Initials f site vitt r; <br /> ? ., <br /> APPROVED BY LAND SERVICES OFFICIAL: /� DATE: /T(p ,. <br /> 7 <br /> UPON APPROVAL: APPLICAN /MUST POST COPY OF ' a ' <br /> •rsx <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , <br /> a <br /> Page 1 of 5 N <br /> Burnett County, WI Land Use Application —Rev 05/2022 L G <br />