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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a _ <br /> N <br /> Applicant Complete All Sections Below This Line o• CD .N <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 11\ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> \ O <br /> /Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 (1\• <br /> 150 °<_ �\ F4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 " <br /> , ie <br /> r"\ <br /> &Campground Structures $125 WI State Statute 59.692(1v)Structures $350 A; E., <br /> Filling/Grading $150 Boathouse $500 '�_ <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1. ik <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: tJU JJ t� v iAi%L \4.) 1\s >_ �°a <br /> Property Owner's Mailing Address: -2.1:75 Z RO(to d L�Lk�. Rd <br /> LAC-k- W1 .s'v S'53 <br /> R <br /> City State Zip < , <br /> Property Site Address: i)0.5-91.5- {pound L a.k _ �c4, � <br /> a � <br /> Contact's Telephone Number: lD Si - 3 3(a— 13(0 Co d <br /> ° <br /> Contact's Email: Lc)e.,i S ex loci e m0.i , . cc YYl <br /> (J oao <br /> Legal Description of Property: Lc P a- C 511 V$ P$ q I <br /> P <br /> Section#: di 7 Town#: 3/ N Range#: ( g W Town of: -Tract e- L a k� 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> ,.i <br /> Tax ID#(1-5 digit number;found on tax statement): 9,`}O 6-2_. .- o H <br /> � 5 <br /> v <br /> Proposed Use of Structure/Addition: 5--�^ck c�e- L.c.n+Q'n c r <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -I <br /> 1) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 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 homes, manufactured <br /> h e additions, and bunkhouses.** <br /> WCo Co's ;Atf -6 be. / o'e ��� r rCy/ ` t <br /> n <br /> JJ II 'w ,�,,_ �'fa'�d f e��O�s 51�y��.�G{ 13. ?6, T Fee Rec: L — <br /> rJ IIF ` � � fit" 4' Check#:_ (� <br /> 3 1/1'�ee�" a lQQ <br /> l se{�ac-�vS 'lt �'Iws - �Qf �A�-I- Q seThe.: <br /> D e of staff site visit: -1111,-V- Initials o'site visi:71‘111I > <br /> ff. f�_ r <br /> z <br /> �j' ' f <br /> APPROVED BY LAND SERVICES OFFICIAL: /� `401/ , DATE: //I�//�� a 1 <br /> UPON APPROVAL: APPLICAN Mr UST POST COPY OF el a <br /> cn <br /> CI)03 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o (Dcn - Cr) <br /> Efilil <br /> Page 1 of 5 m �,� h, Q <br /> Burnett County,WI Land Use Application—Rev 05/2022 < g ey <br /> m = (Jfil <br /> v <br /> a <br /> -o <br />