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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> IV <br /> Applicant Complete All Sections Below This Line ,I a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> A <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 jn i <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 . <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> IN.) g <br /> m <br /> Accessory Structure(Comercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> 7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° O I <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ,; <br /> Filling/Grading $150 Boathouse $500 tJ '- <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 § <br /> L <br /> { <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three timesthe normal fee. i .71j <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. �^ R. 1 R- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o 1�1� <br /> Oack,fia & Pe Pro rty Owners Name: `er"�^ ° b <br /> Property Owner's Mailing Address: 1 c)-S 0\,,ftVIAJ 12 e. C Cuth.,c a- tm S Lit4.3 1 ;`, <br /> City , State Zip _ <br /> Property Site Address: 1)-S C L,1) S�[.t%/ � > ,3 ° <br /> !'- s) <br /> Contact's Telephone Number 40S 1 " (i-f '3 3 A= 1i P <br /> Contact's Email: r (d1 C1 rat.( . <br /> Legal Description of Property: - C `► ✓c I ,iz1 ) 1 <br /> 1 <br /> Section#: �� Town#: `1(40/N Range#: 2)IP Town of: 0��� +N-i( F. 1 1 <br /> 10 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Tax ID#(1-5 digit number,found on tax statement): 1 LEW/q I <br /> Proposed Use of Structure/Addition: S\-ecoy jo(1 g <br /> Anticipated Start Date: 91,.20,� (Home Cabin:Commercial Business;Bedroom;Deck;etc.) -3 O ,H.. <br /> Building Contractor. Sewer Installer. 'I <br /> IQ I <br /> AREA BELOW THIS LINE FOR D SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'z 1-44 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to !p' 1 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured j <br /> home <br /> additions,and bunkhouses.** <br /> 'vim :I I'I'lq`f� �/�b;4.4,41.0,1 <br /> +'� ,/J Fee Rec: ///)ce <br /> Check#: ///'7..? <br /> r3 a-� d <br /> Date of staff site visit: 5 13' Initials f f site vi (� r <br /> APPROVED BY LAND SERVICES OFFICIAL: , 1 / DATE: 1 `?7/? <br /> PJ r <br /> UPON APPROVAL: APPLICANT ST POST COPY OF ! co L^ [IR <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTo N 'A� ; G� <br /> goo 0 <br /> Page l of 53'` <br /> Burnett County,WI Land Use Application—Rev 05/2022 t <br /> 1 <br />