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LAND USE PERMIT APPLICATION —Burnett County, WI o. b t-, <br /> Applicant Complete All Sections Below This Line =' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> a ' <br /> ,Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 vQ <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 (-- <br /> a . <br /> Filling/Grading $150 Boathouse $500 <br /> rn <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 P 6 <br /> *NOTE:After-the-fact permits(permit aquired 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. r. <br /> o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z \ <br /> Property Owner's Name: 3e,_& Lk °,,. <br /> ' <br /> Property Owner's Mailing Address: a-19K0 Flo,o�t iaF F �e- F�„.:1,,yt it.. h., 'SyoV{ � '` <br /> J City U State Zip aZ <br /> Property Site Address: .(`t(o'l $(7;,:t Or..t Iles L« Queue o y <br /> 0. <br /> Contact's Telephone Number: f \a. 9B ti(c. 1.\ d <br /> f) <br /> Contact's Email: �c�e.•i (..1 e-S; as e, ,n, l..c n"-' N "' <br /> aQ <br /> Legal Description of Property: Pc k , in c-t , (oi. y .,c. la, V 3-110-R t gvJ <br /> t7 <br /> Section#: I a Town#: 3-1 N Range#: 1 S W Town of: }...4,4, twK L, <br /> q. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> POeS4.-1 io agk 0'A- ISta.-Qa -to© <br /> Tax ID#(1-5 digit number;found on tax statement): LZ'- $ I ` <br /> Proposed Use of Structure/Addition: 1t-loe�e,/tsar„-% W Q) ° Cy <br /> Anticipated Start Date: l.Sh p (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H \ <br /> W <br /> � <br /> W <br /> Building Contractor: Sewer Installer: ..C._ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z r <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to P' <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured <br /> home additions,and bunkhouses.*n* C ; �/, ',,d b I �,I pQ <br /> • fld'fr3 <br /> :?" <br /> I 6°C171G/� 0 � Vr FeeRec:a1i �a kGe a 7• ' lI '/ .,� 5errn,k- i5 fltry6.74-- <br /> ( -lov 5hee a► 4p re e t' <br /> lat,,,t) �l'�en O��SQ+I W�tCheck#:���'�"' <br /> P P <br /> ate of staff site visit: 9 Initials of site vi t ff: m <br /> - Rill�i7/1A M.—7Epa,t o�NDC RVICEetrFICIAL: (M DATE: l�1 3/ < c <br /> PON�APPR�VAL: APPLICAN MUST POST COPY OF <br /> c <br /> -- q gMC:::::=2 <br /> c a. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z N <br /> . <br /> Page I of © w min <br /> Burnett County,WI Land Use Application -Rev 05/2022 < c c <br /> ri J <br /> C7 <br />