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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> tJ <br /> Applicant Complete All Sections Below This Line 0 N c N <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) � C7 p` <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `; U! <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 0 <br /> , <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 % g <br /> -, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G- Ir\ ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . ir <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r N <br /> Filling/Grading $150 Boathouse $500 <br /> cA ..SA— <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P \ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. ';1? i..., <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1- g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> kli <br /> Property Owner's Name: r/ -/ Aar A-2_7 _ c10kl S 71 °o <br /> �-// r �q,� 4 <br /> Property Owner's Mailing Address: �/ -- C rCci I z e /Sar r"/Ai S5 GEC' '" n <br /> City State Zip <br /> Property Site Address: ' /S)O S pc r-, t La KE'_ Aec esS lid . 7,2« - z. e� ° c cT <br /> i��vvn5 hi p a <br /> Contact's Telephone Number: 7 3 ,a-e7 i`t`7 a d II <br /> : C Ur <br /> Contacts Email: / a-j / m o b ., F <br /> f UhrtSo.►�h2_ l� <br /> Legal Description of Property: /4 "/ �j S/�/ PVis Y Q 7 0 �{C `z� ' <br /> 0. <br /> Section#: / al-- Town#: 2 7 N Range#: / p, W Town of: Tke / i/ 5 441- <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): c 11-I - <br /> Proposed Use of Structure/Ad/lino?: S '0 r de-/lode ba ill P \ t7 <br /> Anticipated Start Date: /IS _o, -- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:NoH Ia%1J &II1L2/lhds Sewer Installer: /1//+ :2:ilW <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY "L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z r---- 'd <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to '0 <br /> ANY construction taking place for any dwelli gs,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.* flQ <br /> ri et-c- 4,11 1Jr- 0 . c I <br /> Di- Lvi f14bt f e‘,4 W 71 a Fee Rec:/'/S1 <br /> -, Check#: S/C 2 <br /> k'I <br /> Date of staff site visit: !O/a5/7 d Initials of to visit st m <br /> r <br /> • a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1O/25/ x -^_'i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF n col Fl y <br /> ._, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT F <br /> " ril <br /> � <br /> C R,�' �, <br /> Page 1 of 5 s-w:i <br /> Burnett County, WI Land Use Application—Rev 05/20222 ��� <br /> K <br /> -9 <br />