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r <br /> • LAND USE PERMIT APPLICATION — Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line ° c tJ <br /> Permit Types and Fees:(Please,check appropriate boxes) ,-- . g <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $1s/;5 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) 200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r p is <br /> Filling/Grading $150 Boathouse $500 i <br /> v) <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> 52 r <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. C cfl <br /> - <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 II <br /> Property Owner's Name: Oil2Y (� /40) l/(/ o 11 <br /> 77 n <br /> Property Owner's Mailing Address: 57.? $ 0. <br /> /{f 7? 9 /2 / A . 4- v. -124 PL " a <br /> E <br /> Property Site Address: /yCl�1�� ��5 City SlaZeL/(g) o a <br /> • a <br /> & (z ' e/� , 2/�` -- N <br /> Contact's Telephone Number: <br /> ri <br /> Contact's EmailFe, _0 " s. J <br /> _ 2.4 0 00 <br /> `-' <br /> � <br /> Legal Description of Property: Let J C � " #4 U Z- B. <br /> go N <br /> P <br /> Cy' �/ N <br /> Section#: Town#: `� d N Range#: I? W Town of: [,/f v‘l es) 2/N.___ 5 <br /> c) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> vn <br /> Tax ID#(1-5 digit number; found on tax statement): 3 S�3 6 7 o ,� <br /> )p x <br /> Proposed Use of Structure/Addi on: <br /> Anticipated Start Date: (97 7 2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (t .-1 <br /> Building Contractor: (((( Sewer Installer: 1 W <br /> O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY e' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 4 <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 bunkhouses.** ,, /�N <br /> O V f- � I use-I {'r' Au& Q 1 4 • <br /> Aar2 6e Mewt0 i/'e f 'v H-► TN's f t �/ Fee Rec: /5 <br /> O ! !t-- SN l�21/44: Z3 p il Check#:C651 <br /> v <br /> Date of staff site visit: /Z6 Z4912-Initials of site visit staff: ,/71-- ,1 <br /> z ` <br /> APPROVED BY LAND SERVICES OFFICIAL: , DATE: 7/Z r/ZDZ i <br /> T MUST POST COPY OF I ci, IM <br /> UPONAPPROVAL: APPLICAN ;-U ,,„ 10 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT k:C) <br /> I Q <br /> Page l of 5 X� <br /> Nil <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> o <br /> v <br /> D <br /> 3 <br />