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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> -• Applicant Complete All Sections Below This Line a N <br /> Permit Types and Fees:(Please,check appropriate boxes) ` a <br /> C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V._ <br /> KAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ti R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 -. II <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o p fib <br /> Filling/Grading $150 Boathouse $500 <br /> vl <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r- g, <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Z .- , <br /> P 'I- <br /> F a <br /> Property Owner's Name: p net. « ct- u I(e 4 ( ? .% 1 <br /> Property Owner's Mailing Address: ,7 4075 iQk led 3S Wpii5iler 10 54243 . <br /> City State Zip <br /> Property Site Address: ,5 4_/1')t <br /> a rt <br /> Contact's Telephone Number: -](5-566-OSU'j N d <br /> Contact's Email: � .dic I l-j ndo LP-I&h o4f i a e I.00f1 <br /> N ao <br /> Legal Description of Property: lei/ Z CC-5,14IZ 27 ,Q, 1-57 . <br /> P.. ` R <br /> Section#: Q Town#: 140 N Range#: Ko W Town of: i0a-K1&net "1 <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): 3 5-,ao g o w <br /> S <br /> hr'Proposed Use of Structure/A dition: 6-a r di C. n b <br /> Anticipated Start Date: q/ 7/(la J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� <br /> Building Contractor: A-hliA local ee.4 Sewer Installer: n /4 <br /> A I <br /> AREA.BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z x <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to Lz <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** / / <br /> C-01 74' h 4,7.4/ '10. <br /> 1/4.b/7 74.014 . <br /> sue ,� / 'C Fee Rec:r-/� <br /> °J- <br /> , ), <br /> b <br /> © s,e /e/71?-e- ibµ nelAdp� 04 w" - <br /> Check#: s(GJ g <br /> 01 <br /> Date of staff site visit: //7- 24.2 2-2- m <br /> 9Initials of site visit staff: '17r <br /> APPROVED BY LAND SERVICES OFFICIAL: , li ATE: o <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF (f <br /> t; tel <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , <br /> c., <br /> Pagelof5 K ;; 1 C::: -1 <br /> Burnett County, WI Land Use Application— Rev 05/2022 1U5 1 <br />