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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> b <br /> Applicant Complete All Sections Below This Line 5� c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> if, Ul <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .,D'Q <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> el <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $150 Boathouse $500 <br /> CA <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. ' r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> ' 6LLi ftPN1iZICtA 0LS° o <br /> Property Owner's Name: a �l <br /> (� r L <br /> Property Owner's Mailing Address: 8 I V i i'RE*a Ra.. WJostik GAT St/k93 w n <br /> 4 C> <br /> nn City State Zip <br /> Property Site Address: PI l`( PAe7 o r`� tie s W t ° A' u <br /> Contact's Telephone Number: /2_ 41022 -- 4133S—6N d <br /> Contact's Email: 0 A £.L- ) fl&A l L- G 144 A 11--. C o 4 N b <br /> Legal Description of Property: L.O"f 1 CS/'& 455-7 If 5 P9 7 <br /> Section#: 0 CD Town#: 3S N Range#: / ep W Town of: YVl EF1NonJ - <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 41061110 cy$,.J6E 1k <br /> Tax ID#(1-5 digit number;found on tax statement): 3 1w•.4 PER t//Oa/ D cno <br /> 6N g Proposed Use of Structure/Addition: &�ev--& C6Yv,('/Qk AAR°io$ S t.RF#1C6 d <br /> Anticipated Start Date: I g Sew f P.°7 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) "3 <br /> Building Contractor: Sewer Installer: —'' W -CSr <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z o <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 /> Fee Rec: i cx- <br /> Check#: E l <br /> �- o <br /> Date of staff site visit: c/�/7�Z Z Initials of site visit staff: r /► tii <br /> z , <br /> 0 ..__,L.�z7 d <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF rrl <br /> CO <br /> ��� <br /> H CCD CC "�'� V <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 5 CD <br /> �, OW <br /> ' c <br /> Page l of 5 `< C-0 <br /> Q <br /> Burnett County,WI Land Use Application—Rev 05/2022 1 Effil <br /> Lc:::_)) <br />