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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V� 5 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V . <br /> 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 VJ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n O 3Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< (V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 C <br /> Filling/Grading $150 Boathouse $500 E <br /> cn 0Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 t e-k <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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> JP <br /> Property Owner's Name: /V\OWS"C l_,LC LYle.Jul ,4e.t'`, N <br /> �� c NI <br /> Property Owner's Mailing Address:k\2, 'Fparyv ep l_,n n tJ <br /> � City i State Zip </ <br /> Property Site Address:a°k 5 v.e,trfQc, , ?c S <br /> Contact's Telephone Number: S)S-'777—535-- o <br /> Contact's Email: KQjjkY\•‘c(st;s4Kto� (� ,v c C� \ .CDYY� R15W Townvt y�� <br /> tat hi&,io VoyAgu- VrSac, T <br /> Cloit, s tO �QN <br /> • <br /> Legal Description of Property: ,rneM fo.Nn � ,M en-eta.- -IS-10-5 Is-IX©- QOO tac.tr�,i,%' !1 o IL) <br /> d 0 <br /> Section#: 10 Town#: y O N Range#: I W Town of:Sof Qe ^' <br /> N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number; found on tax statement): .] G 0 P <br /> Proposed Use of Structure/Addition: „e,/COb� , xe. <br /> &_.C.--- -..‘;;) <br /> Anticipated Start Date:10-'01'A-n (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 <br /> Building Contractor:A rOZ, C f04. Sewer Installer:J1/4, 1 ?kvotiALT <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <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 bunkhouses.** <br /> bikellit <br /> mom 11 s�fb4d46 <br /> �+ do err e ) �i60016 per SAW- a2.-?? Fe <br /> � Fee Rec: <br /> / c, Check#: t <br /> Date of staff site visit: ( 0 I a7 1 ? Initials f site vis' st ff: ✓ o <br /> rn <br /> z <br /> o , <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1ola ?a � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m a c) <br /> a rip r9 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o z s-- ffi <br /> y � <br /> m4 a <br /> CV Q <br /> Pagelof5 x w= ,z, <br /> Burnett County, WI Land Use Application —Rev 05/2022 < m '" <br /> o <br />