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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ° i i <br /> Pp p c <br /> Permit Types and Fees:(Please,check appropriate boxes) .. e �1 <br /> d Ss <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 ) <br /> tM=Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C).) z <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Z.... ° uo�` '�\ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> DD <br /> Solar Panels(Stand alone or roof mounted) $150 x 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 — <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o , <br /> li <br /> Property Owner's Name: r.r�/ .- M^{ i' a,�.k,a Sc._ ,\,k Z ' 0 <br /> ( J <br /> Property Owner's Mailing Address: (oOD, SlNo.r v,si.teil fir+ C40e c \ft. {I- 32,5x,0 <br /> City State Zip c CJS <br /> Property Site Address: •,"7 Ettg I..,,,, c_Q\',, 5k• Web.s-st ' r WT 5r-1 B ° g <br /> Contact's Telephone Number: `S( 3 4\ - $ i-k g L4 d <br /> .. <br /> Contact's Email: s c lo.i_k{z e w.Q c sk.IN T st 1, kt. • �-e'" N -o <br /> 0 o0 <br /> Legal Description of Property: L 1,1 1 Y.N. a e 4"-+ es C stgis-C 5 a <br /> ` <br /> Section#: 3 'J._ Town#: 140 N Range#: I (o W Town of: C c `c wk.c� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> C4 <br /> Tax ID#(1-5 digit number;found on tax statement): ILA 1\ -7 W 5 <br /> 1....LE) <br /> Proposed Use of Structure/Addition: Cs, �.r�q e N ° d <br /> Anticipated Start Date: `( '. (1-1- 'a ` ' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) . -3 <br /> Building Contractor: S \-. Sewer Installer: N e tr - A —. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ,Q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z .x <br /> 11.. N <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 /> Q 17A 1'S is aki .e-KI idti of• Z._u,-2/-5-7V its perkt„'/ <br /> eikp/itQ ole 9 Z f zc,Z3 •• /OD C°— <br /> / Fee Rec: <br /> �ClACZ-fY7Dk15 wZ-U/-Zl ^S7 / .5/7 7/ q'P//' y Check#: 14 77 <br /> / /2- 2OLZ _ v <br /> Date of staff site visit: t` Initials of site visit staff: �2T m <br /> � u <br /> APPROVED BY LAND SERVICES OFFICIAL: , DATE: 9///ZZ_ <br /> FrO <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF w co r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br /> .o Q <br /> Page 1 of 5 ` <br /> Burnett County, WI Land Use Application-Rev 05/2022 <br />