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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> " Applicant Complete All Sections Below This Line 0 c tJ <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ..� O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Y <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ppp <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 —ra <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 4 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. g' I ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> ili <br /> II .n N d <br /> Property Owner's Name: 1✓AD,Wafe Ziss.,i) biAl Li n. t <br /> Property Owner's Mailing Address: /b k 11 Pf I'4_ ,L°i (,IV i It Y;41-5 Iti)N ;!f i i ° n <br /> State <br /> Property Site Address: 7-7-'7or a 414 La. f)-A r , �Nf c l . uJ . c'1 kP� Zip ° _' <br /> Contact's Telephone Number: w. 3 ``q Z 3- 3-'11-/-z- ..t d <br /> CD <br /> .. <br /> Contact's Email: $L ZiOy 0 ci� �, N <br /> Legal Description of Property: o <br /> P ..;1".--- <br /> Section#: () / Town#: 3/ N Range#: / "7 W Town of: 4 W U6. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): /0 r ' o <br /> ' _ <br /> Proposed Use of Structure/ ditio : lib m �' 1 f3 (3C. o .l eit� (4eW(l — <br /> Anticipated Start Date: 2 C/ 1 (Home/Cabin;Commercial Business;Bedroom;Decl/;etc.) -3 r <br /> _ <br /> Building Contractor: / Sewer Installer: Q' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ``f ,-Q. <br /> ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z .....1 <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 bunkhq ses.** <br /> (Il eek a,II Seita c k <br /> r1, <br /> C f .✓Ie, s P y Check#:;7 �� <br /> tA <br /> Date of staff site visit: 91731 ?-a— Initials o site visit : i' <br /> /--- rr,a <br /> � / z <br /> C(f <br /> APPROVED BY LAND SERVICES OFFICIAL: I DATE: 3/2j <br /> z C3 <br /> UPON APPROVAL: APPLICANT ' UST POST COPY OF m EG <br /> FT r.cf60 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -*3 — fill <br /> { -0= <br /> Page 1 of m �� <br /> ro <br /> Burnett County, WI Land Use Application—Rev 05/2022 < ro <br /> m = <br /> 3 <br />