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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> - b <br /> Applicant Complete All Sections Below This Line a c w <br /> Permit Types and Fees:(Please,check appropriate boxes) /- z. L° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 19 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk unkhouse $250 G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i' "),) <br /> Filling/Grading $150 Boathouse $500 <br /> u *- <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 C <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. " ` lb <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r 0, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z 116 <br /> 0 <br /> F <br /> Property Owner's Name: . i . irm.....o lZ I NA Qc.-/...G-s4trr_ 0 to <br /> Property Owner's Mailing Address: �7 0 LG L1iw -Z. y,4,7 L.c>N&L&iG.„ , 4/10 `6.3 _, <br /> City State Zip <br /> Property Site Address: I /3(0 Zez:a/ r,tr.5 JZ S. , .$►P0ez 4EC, W l 5'/8 e., ' •o N <br /> Contact's Telephone Number: 7 Co 3 - &s-c) -94 .3z. e <br /> too <br /> co <br /> Contact's Email: . &tJ L..I S QC.t,-.CCG„t e k, Coe&& i c. . rr..-. N <br /> o 00 <br /> 0 <br /> Legal Description of Property: ? -S &i J/ Lori ' l7GS� S,t Z//ag 4. Z7'/'i3 S Es If 351'>3� <br /> -- I-cT z6,-D-3s► o <br /> Secti #:01 Tpwn#: O- . N Range#:1 -W Town of: ..oTt <br /> 5. <br /> *Attach-add do page if needed for lengthy description OKaf'tach a copy of the deed OR attach tax system property page.* <br /> C4 <br /> Tax ID#(1-5 digit number;found on tax statement): i F3 Li 9c) b o <br /> F <br /> Proposed Use of Structure/Addition: C...6.6,�4 �!J!r.l=- ° t, <br /> Anticipated Start Date: A u G Zcny 2, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: 1Znt zr , v./ Sewer Installer: r'' Q <br /> .i1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to pJ <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured -...... <br /> home additions,and bunkhouses.** <br /> prie.e— a,II S <br /> ��jjv25 � Fee Rec:o2Lb Ck. <br /> 5411 i <br /> U s�'K IA.I1ta0 Cs� �v y Check 151_1,464/9 <br /> Q L o . � ksy <br /> Date of staff site visit: 7i 131?O' Initials o site vis $ i <br /> APPROVED BY LAND SERVICES OFFICIAL: >� DATE: �I�7/�� x <br /> fi <br /> UPON APPROVAL: APPLICANT UST POST COPY OF a `c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> NJ <br /> Page l of 5po g <br /> Burnett County, WI Land Use Application–Rev 05/2022 <br /> m <br /> O <br /> ;n <br /> 3 <br />