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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> ro <br /> Applicant Complete All Sections Below This Line cN <br /> Permit Types and Fees:(Please,check appropriate boxes) °) , h <br /> d _ ` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 w' g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-' • <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 JJJ���+++ <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> i <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. g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: I I/it l�/V; �' / 4L� n <br /> ' d I <br /> Property Owner's Mailing Address: .3'( - ""��' D1 ice-'P(-' � t't i/ / 1/di 5:5113 ° '' <br /> ,�-►^ t City State Zip <br /> Property Site Address: r7 7 4 f COUI j7(/ /�peret l - D. Cl I I 5— ��.. ° CD <br /> Contact's Telephone Number: t t h ��'— S�3-.. . i'13 d <br /> CD <br /> Contact's Email: f C KOG(„3`1""t, A 6g 04- yC+ 110 t'' <br /> cio <br /> Legal Description of Property: lie 4c -. <br /> t-1,01) r'14 / <br /> Section#: Town#: N Range#: W Town of: - # Me eklc <br /> d <br /> E. <br /> e) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> CA I <br /> Tax ID#(1-5 digit number; found on tax statement): / 2 i',5 6 o <br /> Lam� _ <br /> Proposed Use of Structure/Addition: , ,L-_f 3C),' ( / b <br /> Anticipated Start Date: 9— 26 -• 2 - (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^3 <br /> ! ..—... <br /> Building Contractor: CL'?)'r7( VI`s^`T 4.0 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to po <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> ho e additions, and bunkhouses. * <br /> ØriA- 411 se1-1 &pS <br /> b-S ,,,. <br /> -6( kMf1 b. <br /> Fee Rec <br /> x <br /> v, Check#:( 5{h <br /> Date of staff site visit: /d-;/2.?- <br /> Initials i site visi t j/• � ��� <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL. /' v-41.."----L-DATE: 9 /0?-? <br /> c�.r <br /> UPON APPROVAL: APPLIC • MUST POST COPY OF m o <br /> a l`� U c. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z �; m U <br /> -< MJ (.t _ <br /> Page l of 5 r <br /> Burnett County, WI Land Use Application—Rev 05/2022 m C] (' <br /> G <br /> N <br /> ). <br /> -o <br />