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cn -Iv <br /> LAND USE PERMIT APPLICATION - Burnett County, WIr <br /> a <br /> Applicant Complete All Sections Below This Line 0 N <br /> n.' <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> 7 Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,,,0 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a A <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 Z <br /> Filling/Grading $150 Boathouse $500 N <br /> fkl <br /> Solar Panels(Stand alone or roof mounted) $150 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. '..D. p, . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. % (� <br /> Z <br /> Property Owner's Name: �J�a,a. t0 Z- G\A c o -c- N,► <br /> Property Owner's Mailing Address: 3(n ) Vi0.1Q. • A vt--, ..' ' - <br /> 4.t '` ' <br /> City State Zip C <br /> Property Site Address: 2 q9()‘ I ine.f VC)`- Li rd e-- .r -c :AJ,C\ kAii •6:. ) . ° g <br /> M. <br /> Contact's Telephone Number: In j 1- 7C)7- 59 t7 <br /> CD <br /> Contact's Email: 13ri4 e, V.,.( PA N ,o <br /> o <br /> Legal Description of Property: ; <br /> �� / --� a P Vf r (2, A) Sly <br /> 5 /U t = p� <br /> r o <br /> Ci. <br /> Section#: % Town#: y I N Range#: /6 W Town of: b1,4/..53 y <br /> 3 <br /> . �1ta <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): o ;C) %'- -i ,,,73 <br /> (- , x <br /> Proposed Use of Structure/Addition: l d <br /> Anticipated Start Date: 01 - 1 - ag, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -a <br /> 4,4 ...,,, v <br /> Building Contractor: (r, "/ `` 1! Sewer Installer: p.�l�,-I f 1�',,� of <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z No. "„,! <br /> 73 <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 /> 0 120( lb 5.1114duv� is oK/y be. U sc .a/as, f she 4107 no q �� <br /> [YW`l11N9t ylo.I us� -r AUY�41. LiafII ol7-+a'770N1 . <br /> Fee Rec:' <br /> 0 Ajd- 74, e;�.�L 5- ( e..,4 vrvls pe-,' SA/v—Z z " z/7 Check#: '91G S <br /> Date of staff site visit: g/Z3 ZOZ.Z Initials of site visit staff: '0/7; m/ r <br /> (APPROVED BY LAND SERVICES OFFICIAL: DATE: ?//3;9Z 2-- t '—�-J; <br /> RI <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF I W L <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT I <br /> 0 r WeU U -� S� A2e a l✓` 6 / fH Page 1 of 5 SN <br /> Burnett County, WI Land Use Application—Rev 05/2022 1ND <br /> d <br /> i' <br />