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LAND USE PERMIT APPLICATION—Burnett County, WI a r <br /> ° <br /> g b <br /> 0 N <br /> Applicant Complete All Sections Below This Line ci' CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) dL: <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <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 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C7 Q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 6) Ilii/ <br /> V Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> v, k <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 Cb =. % <br /> 1. <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. m <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> Property Owner's Name: ��l�l-�5 J' /'I'Cott �C I '�/�� a �` lb <br /> Property Owner's Mailing Address: P. 0, a)K Z3-) (blebs* (AJ,2 SeleeiS o' rrn <br /> City State Zip 4 <br /> Property Site Address: Zi (D7(, I�ri?A 14 ea <br /> n <br /> Contact's Telephone Number: (057 —3 I8 —12-1 L o <br /> Contact's Email: LS 1J►^'td'2`- e tiqkt) , ce'". <br /> o a <br /> Legal Description of Property: j_ <br /> Section#: L1 Town#: 4 N Range#: IS W Town of: —1 A ks o"J <br /> ' <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): 5-170 .31=. Cb F H <br /> Proposed Use of Structure/Addition: - P3 -o L:4-k4-- - <br /> Anticipated Start Date: f'—�0 ZZ/ (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) H1 w <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY D d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> "filer applicant needs to contact their IDC Inspector to determine if a permit is needed front them prior to <br /> -INV construction raking place far anl'dwellings.dwelling additions,mmatfactured homes:rnitnu/actured U <br /> home rrzftdi�it�tttd bunkhouses11 .*" / 1 — <br /> u5+ be abode � Qrdlmat Fee Rec: <br /> r (� co <br /> Check#: ( ()S <br /> I?t h)-a- ° <br /> Date of staff site visit: Initials of ite visit s / r <br /> / z <br /> APPROVED BY LAND SERVICES OFFICIAL: I,e / / DATE: { 2e m __S-:=13,j <br /> UPON APPROVAL: APPLICANT ST POST COPY OF r 4 4 [Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> liiiii <br /> r to <br /> 0 o C7 <br /> Pagelof5 m � _ r <br /> Burnett County,WI Land Use Application—Rev 05/2022 <br /> CD YE <br /> t7 7r <br /> b <br /> I <br />