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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> b <br /> Applicant Complete All Sections Below This Line 5' t� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> i,:,,-, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..D O <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ` <br /> 0 i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° o � <br /> ` <br /> v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> i <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. 0 <br /> A)1 <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. r g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g <br /> Property Owner's Name: I f) r'Yl o'C k y an A D r VY\0. R 1 GC l' _ a, <br /> Property Owner's Mailing Address: I (3 c I \v"k t 5 p e r,13 �1 ' Cs Pk. C r'e4u't C it(); CV B. <br /> City State Zip < ►r <br /> Property Site Address: I35 ( W h IS P nrl� Pi t1, RJ }' reLltrt L i Sy S 3 7 ° c <br /> _a r\ <br /> Contact's Telephone Number: ( S - 3,R — 8 Qs— t7� ► <br /> 1 CD <br /> Contact's Email: l'1 O►'1-1 1 On a+ O o O ( o rn a r 1 - c. 0 N <br /> tioILegal Description of Property: PA rce ( 6 1 50 u_ est $u ar4� o-( I AIR) !s��c�fero•( <br /> Section#: T Town#: 37 N Range#: le W Town of: 1 r Ld e- Let e. n <br /> a. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cA <br /> Tax ID#(1-5 digit number;found on tax statement): 3 SL b 'P c <br /> me � / (� <br /> Proposed Use of Structure/Addition: �w � ''l� ��ora gl wors kop . d 1 <br /> Anticipated Start Date: Dec— 11I 2 0 2 Z- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,\ <br /> Building Contractor: SG)' u,a v4 z Bros . Sewer Installer: y\o rl. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> x r <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 bunkhousesi** <br /> 0 ee+ cdl 5e4-b, , <br /> -6 hui/'►'lan i6/I�t`'�01114 a Fee Rec: /5O <br /> Check#: ( / <br /> EA <br /> Date of staff site visit: lb-CV}-2— Initials of site visit ta r <br /> Q'/ <br /> APPROVED BY LAND SERVICES OFFICIAL: ` DATE: jf ��)? EJ <br /> UPON APPROVAL: APPLICANT UST POST COPY OF r- gill <br /> L„ <br /> ru <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z wtiiiil <br /> r w n <br /> O C7 <br /> Page 1 of 5 m 2 ra <br /> Burnett County,WI Land Use Application—Rev 05/2022 < g <br /> m m Ifiiil <br /> v <br /> 3 <br />