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• LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 c t.) <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 )< Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure 1 $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse ,$150 3 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> ---, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> ,S,' <br /> Filling/Grading $150 Boathouse '$500 IP <br /> cA <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g. <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. CJ\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. zc. <br /> Property Owner's Name: 11/ di L I IC /'Y) �`1Ct+tf` 0 <br /> ;l <br /> Property Owner's Mailing Address: ;3(30 Pa Glu�, Rd Dclh13 N1 S1130. n <br /> City I State Zip • <br /> Property Site Address:2-C1Oi eak4C(r, (2 GA o a&i ihr y 1.J1 h S y %3 0 ° N <br /> Contact's Telephone Number: 10 S I P-7(.1 73 5 1 <br /> n <br /> Contact's Email: h)(1- --Ce( ehoelc N ' <br /> Legal Description of Property: R iVim- Oak S Lo -V- ;---7f IA(3 I h 1- I vt Ou+ )451-1 I 4-2 So <br /> ' <br /> Section#: ? Town#: 41e9 N Range#: 4 C7 <br /> g l� W Town of: Oak a•. N <br /> 3. <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): I 43 1 I _ 1 H w <br /> Proposed Use of Structure/Addition: , A i hc)-N Close . -f )3✓e4 24...t c7, 1-1 k-V Ckt '.1 V 5 <br /> Anticipated Start Date: AgAe (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t -� Q <br /> Building Contractor: S2 i ett Sewer Installer: P/A .4W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ? V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to rk-'S <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses„** i <br /> / <br /> g/us- <br /> p <br /> ,4 eac CAe.€2.G1 3 e.2 r' w)S pee sa rt,Yar y I70 7i <br /> 441e- r'l✓°l,rs/WC. deck— corns "AG Q (.1'/ OCI� er P4' Tj Fee Rec: 7m <br /> N 4) be v>°.w40 N bt� 611/20z3. �-, Check#: .3127 <br /> CaN f b2. Gl/c W S / C,, <br /> ;1;7— <br /> aDate of staff site visit: C 26i/Zd L Z.-Initials of site visit staff: m a <br /> p, z <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: ! Za70 2. `, BOJ <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF m Q Lr* Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o �7 <br /> z N . uBu <br /> Zol a a Z% 0 a' <br /> Poe 5fj cow b we e�+n Q c <br /> Pagelof5 R , Gam" <br /> ix lel 'es. <br /> or q la N al Burnett County, WI Land jJse Applicat'o -Rev 05/2022 < a "' <br /> MI <br /> us Jj <br /> 6$ s s pg 5/- alp,,e. - a^ 5er't�G u . 3 L <br />