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LAND USE PERMIT APPLICATION — Burnett County, WI a gb <br /> Applicant Complete All Sections Below This Line t� <br /> O. <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 rD <br /> .-{ <br /> XAccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-. � <br /> • <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ►` <br /> Filling/Grading $150 Boathouse $500 P <br /> CA <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R r <br /> l' v1 <br /> *NOTE:After-the-fact permits(permit aqui red 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. �J` <br /> Property Owner's Name: /�CL eV-- 5C/liW ✓ .C...' r--- $ <br /> !: <br /> Property Owner's Mailing Address: ZG3 q ��t �CQ 35 sd oors4.'F' Ai( sivz 5 w� n ,E <br /> r , r City State Zip <br /> Property Site Address:At 20t � $T��gcQ 3 G De,rt I,•w!../ t .• ( . <br /> Contact's Telephone Number: '{S C G Z 7 4' .1, o <br /> FD <br /> A <br /> Contact's Email: Qdt a h/�0 Q u ad S ha pe-n�wt S• C'c '� N U <br /> ll o <br /> Legal Description of Property: d <br /> Section#: 2 a _Town#: SI0 N Range#: /6 W Town of: Clakidest Cl/ 5. <br /> n <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): 13 1 3 5 c> 6 o <br /> Proposed Use of Structure/Addition: 60 5)A e 5 S e <br /> Anticipated Start Date: aritib id . a• 2.2, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H _l <br /> • <br /> Building Contractor: 1A f.w` 5aw in&Q.I.g.er Sewer Installer: N'. /f/p,-.w � `k <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z r -.r._ <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 bunk4ouses.** pe/ Cede <br /> (bee* all 5e44c luS 7/a"s•- h a µad f a'r k'3 1 <br /> s}y,,,ci„c. two �o e'ctee�r 5 e'"' )kfees a•� 2..fiDer drq;n s ete sari *;3-6 3 <br /> All 'k e cot 1ti eraa l is-l.b ;n lec�'o",s la. be �otn r le•�ccf• <br /> _i Fee Rec.`00� <br /> No�re✓ '� { 6�{,0.i�b/1. 1 ` Check#: 514,5 7 <br /> n` v <br /> Date of staff site visit: L0 Si?-2. Initials f site visits ' m <br /> r <br /> z <br /> z <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:io y/2- a Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N Q Nil <br /> > Cr)w r-n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z 5 C N © <br /> r 0 c.t� Nil <br /> -< Q o p <br /> Pagelof5 <br /> Burnett County, WI Land Use Application—Rev 05/2022 a NJ <br /> m <br /> v <br /> cn <br />