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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) a F <br /> y..., Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> No F <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <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 <br /> c4 <br /> PD <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> E. <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. 0 _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Z <br /> Property Owner's Name: 'D/ L� Sc(Z/4/J 1 L /Z /4 I 4. <br /> Property Owner's Mailing Address: 13 WI L(--oc.c) L/4, S. 1-1-3 ,?PO-WW2-f(gJ OPAL 5. cn <br /> City State Zip c . <br /> Property Site Addres49'DA DQILls 3 S t- 4) (1.- /4 Liz,_-Mel fLet,Ai% y rit.33 o F g N <br /> Contact's Telephone Number:2lige I IL k t t 4id Ce'8d 77.4e S=pe4 7 ( -7 <br /> j�t'2 c ? --©v z 2 Pt , <br /> r <br /> rp <br /> Contact's Email: d fla-e-t -4i l2/U 6.(ZS --,j0 t2-r-74- C'CA-1 <br /> o b 0 <br /> M. <br /> Legal Description of Property: 'J ,, -1/11-77 e ft' P - vW► <br /> � 1� <br /> Section#: Town#: N Range#: W Town of: 'Al DJ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> EnTax ID#(1-5 digit number;found on tax statement): 17/ o� <br /> Proposed Use of Structure/Addition: A/ cu..) &(O#-(6: u•) d <br /> Anticipated Start Date: As /977 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H �/ ) <br /> n <br /> Building Contractor:giuc(ZS b 1 0/2-1-74 teO,tisr-Red T?Pver Installer: ef©f2a."N`7 <br /> THISC W <br /> AREA BELOW 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 /> liPtYiee4 c4,1 Sel-betc(P5 <br /> Ds",clt:r ii,oi- cxceej a becievoi45 per s6P- .2? - ?35 Fee Rec: 3 cf�,.�-Check#: 'IC-7 <br /> a <br /> Date of staff site visit: 1 0 `I gj('a' Initials of site visit f. r m <br /> 1 _ —�--o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: (�f��l tr U <br /> a <br /> UPON APPROVAL: APPLICANT UST POST COPY OF F 4 W � Ste? <br /> 4 _ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o -� <br /> Pm = N.) o <br /> Page lof5 m ^' <br /> il <br /> Burnett County, WI Land Use Application —Rev 05/2022 <' <br /> n <br /> T-- <br />