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a LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line o trf � <br /> Permit Types and Fees:(Please,check appropriate boxes) n. <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $20 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 k •,l <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 6 1 t <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Q 4- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o h <br /> pit <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 '� o k) k% <br /> Filling/Grading $150 Boathouse $500 'Ilk` <br /> k <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a. <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. . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 0 <br /> Property Owner's Name r;glA RDb0 1X` n �` <br /> v-v <br /> Property Owner's Mailing Address: <br /> 1etv�1 e \ E k (6-L.,6 Vivov6,) UP(5 <br /> City State Zip N <br /> Property Site Address:A-1 -L -� <br /> 0. <br /> am-`` <br /> Contact's Telephone Number: I(6' LT` /ct)4 Ap,�r it et ^\ <br /> co <br /> Contact's Email: A11114(00e—di--P,-- (d 00 OMN <br /> o <br /> cro <br /> Legal Description of Property: �(Q 47 Z�j crg <br /> d <br /> Section#:01 Town#: 4 O N Range#: 140 W Town of: OCAY-Aatra <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number; found on tax statement): 1 4 '/ 1 ` o <br /> Proposed Use of Structure/Addition: �O�\ b 1 J 5 <br /> Anticipated Start Date: a3cAT (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Vsl C3 <br /> Building Contractor: `7'�\.f l Sewer Installer: —Z AA ^� <br /> W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 11 v <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 /> Qc 4,tyar yard- , u roe, ,n 59t Il" / sem. /�f f re N e... <br /> a P er�wf"�tl t• t ,y/� i �� r / r M Fee Rec:G <br /> No Ac-W I e N 4 ' b e. 0 i4A S I‘ /A I's G1 Tl e 1\ r N Check#: <br /> o <br /> Date of staff site visit: 9 Zo1VO Z Z-Initials of site visit taff: p.,, - m <br /> a U <br /> AIIIP z <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: q/0 ZZ o r <br /> < a • Iffl <br /> r <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF rl <. ill <br /> .. n 1 <br /> co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> -< ^ <br /> 3 <br /> Pagelof5 72 <br /> Burnett County, WI Land Use Application—Rev 05/2022 L-----) <br /> . <br /> a <br /> K <br />