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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o cCD t� <br /> Permit Types and Fees:(Please,check appropriate boxes) n' <br /> 2C Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <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 /> CD <br /> ., <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° Ab <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> i" it <br /> Filling/Grading $150 Boathouse $500 111 <br /> v) <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. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> 0 <br /> N N <br /> Property Owner's Name: /1 t.9/1 L• 114 t € C6 lz N <br /> do-&-4-14.414,2A-e._ b l <br /> Property Owner's Mailing Address: I§'97D--41 ' .4.4) oiv-4......, `gyp 'II se-' 1>J6 5. <br /> �% City State Zip < <br /> Property Site Address: 3/3 SSS. k�4L-,/,•. A)4 -{ cti e 3 4 \ ° G <br /> E. <br /> Contact's Telephone Number: 'c{ - ..9 6 il— 4ik 7 d <br /> Contact's Email: /C► <br /> o <br /> Legal Description of Property: 7 �/� 5Z 6 �, e?‘73 w <br /> d <br /> Section #: /: Town#: q/ N Range#: /6 W Town of: Si"---4-(- N <br /> n <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): iTs.38. <br /> .- o <br /> Proposed Use of Structure/A ition: (1- <br /> Anticipated Start Date: 3-) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' H ,n <br /> Building Contractor: Sewer Installer: .. 4.6,,,,,,_47„...L...74,01(4/1 W v ' \ <br /> .%;AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zN <br /> **4The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to z <br /> 09 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> ome additions,and bunkhouses.** <br /> Ns- 7 e4C&C eJ Z- b e I-v o s p w' S 4/U- 2-2--/.r/ <br /> 0 CD <br /> Sq- M l L I Si)eco/^ 740 eh-4/ !/‘ p P.Y'1.t/11/ , ,, Fee Rec:3DC).- - <br /> Check#:4=2/0 q <br /> CO <br /> u <br /> Date of staff site visit: !f�a/DZ Initials of site visit staff: i/ /- m <br /> z � l � 1 <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9 /3 ZO2 2 <br /> a <br /> < Pi] <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF y g g3 ` 0 <br /> a g m r.) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z .0 <br /> Page l of 5 m �U <br /> Burnett County, WI Land Use Application—Rev 05/2022 a - <br /> m <br /> L......____..--) <br /> a <br /> K <br />