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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> ,. `' tJ <br /> Applicant Complete All Sections Below This Line 0 a N <br /> Permit Types and Fees:(Please,check appropriate boxes) _ // d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200� 9 <br /> Commercial/Industrial Structure $300 A ition teration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 54) <br /> • cessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> � o t C__ <br /> (���I/�o•ck -airs/P io etaini all/ w Bunkhouse $250 r <br /> �'�� • ewa &Camp nd Structures $125 WI State Statute 59.692(1v)Structures $350 0 c)o� <br /> Filling/Grading $150 Boathouse $500 cyl (15n <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. Ty <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z , <br /> 0 <br /> J I n^Property Owner's Name: e ph ) J ,:,. <br /> .c <br /> Property Owner's Mailing Address: (t � i E n •�V Gte 't I n kOr i °1"N `- ,0 C3 <br /> T � City,; State Zip <br /> Property Site Address: 0 l 30 Ha,f1Gc-0e1 1.-ck` tr -i I I,uee l.t Ua-ftbur ....L.. , <br /> q 1 t�>� a <br /> Contact's Telephone Number: ��,� 1 1 (JL`� d <br /> w <br /> Contact's Email: rY1 Gt.,f l i Tf! Yy6 n , �Q 0'l �- "t' ..� N e <br /> cro <br /> J 1 <br /> Legal Description of Property: ' ..)00,,,k L tr e��� 9-i"��0rt ��v�a/c-v t t,�� k <br /> t7 <br /> Section#: Town#: N Range#: W Town of: 2.6 tj <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 /> C" <br /> Tax ID#(1-5 digit number;found on tax statement): (CI SO 4 G p, o x <br /> Proposed Use of Structure/Addition: C7W ' / G ck.\c:3. V` <br /> Anticipated Start Date: C. ►-k-cjVje,m-- I,. g,1,:?r dome/Cabin;Commercial Business;Bedroom;Deck;etc.) '- ..__p eZ1 <br /> Building Contractor: .J E1(+ei of. li '.,,q!1 Sewer Installer: <br /> a <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z "t' <br /> **The applicant neehs 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 hunkhous <br /> s.** <br /> s.**/ <br /> leekcv d 5 c1-S$5-\-0G-6re aces not. I ScfC SGI-b r.ek5 b.A'F" <br /> (2DIQei✓L�' Fee Rec:. B'� <br /> l A5o1/IL ( / - ;.�cf e i•n 5;Ze II7, Checks: 7 <br /> Date of staff site visit: 10 1) 70- 1013/7?Initials f site vi ' s f m <br /> APPROVED BY LAND SERVICES OFFICIAL: r DATE: 16{45/ X. Nil <br /> UPON APPROVAL: APPLICANT UST POST COPY OF m m <br /> -,Z 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ro <br /> Page 1 of 5 03 <br /> Burnett County, WI Land Use Application —Rev 05/2022 'ig <br /> y <br /> ro <br /> 1 <br />