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LAND USE PERMIT APPLICATION — Burnett County• , WI a 9 b <br /> Applicant Complete All Sections Below This Line a' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) 1cl ��� <br /> Dwelling/Principal Structure $30Q Addition/Alteration to Dwelling/Principal Structure $200 \ r <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Q <br /> Accessory Structure(Garage,Shed,etc.) _$150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Az <br /> Solar Panels(Stand alone or roof mounted) $150_ Permit Extension(1 Year Extension-Allowed Once) $100 w <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. i <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. t- 5' <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z ►` <br /> -n V <br /> //r er o a <br /> Property Owner's Name: _4''ltl ._ R.1 c:'4U <br /> m. <br /> Property Owner's Mailing Address: 'errs Las Am w44f.c 7L• (OI Ge v <br /> AZ•'c.7/0 S. ' <br /> �f f-W, fr—r City State Zip -= <br /> Property Site Address: Cj♦77 04k _ CQc-. - toT Virg G <br /> E. <br /> Contact's Telephone Number: I421 IA 1,,91 -e Y (Tr ,Sufi 7/6=4(4 -opt 3s", o <br /> CD <br /> Contact's Email: Alt IJi1G /44 e het5n,G4,r,4 C LC. sir v to 54-reir-4-r0., .C-44 , '— <br /> N <br /> o <br /> Legal Description of Property: Sw 4! No rel vtki. tot6+4.0- <br /> Section#: z9t1 Town#: VO N Range#: igW Town of: .__ 0.) <br /> *Attach additional page if needed far lengthy description OR attach a copy of the deed OR attach lax.system property page.* <br /> N Tax I D#(1-5 digit number; found on tax statement): 33�7 _'l o <br /> Proposed Use of Structure/Addition: eK) CO(4211.e_ d <br /> Anticipated Start Date: kV1 1 ', (Home/Cabin;Commercial Business:Bedroom;fleck:etc.) -3 <br /> Building Contractor: The, Sewer Installer: S v i� y ., <br /> ,_ <br /> t,'N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z U <br /> 70 <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 addition• and bunkhouses.** ,--c... <br /> The ei ail sel-bo,c <br /> tivel t I/Y' evA- Q eCc�P6 3 bQz(✓ 5 ?el' v'! "' - Fee Rec: C ca <br /> c <br /> V _ Check#:..5--”9 <br /> ������� (D�31� a <br /> Date of staff site visit: t Initials o site vi' s • r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: io p�i l/3) 7:, , <br /> ,.„ <br /> ,,, <br /> � <br /> < ,._ , <br /> UPON APPROVAL: APPLICA . UST POST COPY OF ro Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a H 3 <br /> 4 N 0 <br /> Page 1 of 5 ,� C <br /> Burnett County, WI Land Use Application— Rev 05/2022 -- 0 <br /> m 3. <br /> O <br /> 4 <br />