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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a 2 t~ <br /> b <br /> cn Applicant Complete All Sections Below This Line o tv <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) VOL ,-. ,-, <br /> d !V <br /> Dwelling/PrincipaI Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure�`` $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> KAccessory Structure(Garage,Shed,etc.) W 1517 Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �j <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t P <br /> g \N` <br /> Iv <br /> Filling/Grading $150 Boathouse $500 <br /> 07 <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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: �L Y r1 L e e <br /> Property Owner's Mailing Address: :)-}01 U 5 ice%cad LPL Ke- i vi 1 Grrc-s.l Sbc vn w- S4y4 i <br /> City State) Zip <br /> Property Site Address: t()‘'A o <br /> 1 . 2- <br /> Contact's Telephone Number: 'I S -IA( 3 - O lx 3 d <br /> Contact's Email: �e ya CO- t)2)I G C� Qcti'f 100K • Le o o <br /> Legal Description of Property: V tee 6 a <br /> � <br /> Section#: 2.5 Town#: S N Range#: ! 8 W Town of:t�✓C7CV( ,�C <br /> d <br /> 5. <br /> *Attach additional page if needed for lengthy description OR <br /> attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): d-'8 q,q 3 <br /> „Le-.o..c), V, ° <br /> Proposed Use of Structure/Addition: G v a c.- -i c L._ <br /> Anticipated Start Date: al)/io (1-tome/Cabin;Commercial Business;Bedroom;Deck;etc.) • <br /> Building Contractor: Sewer Installer: G1 <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 p' <br /> ANY construction taking place for any dwellings, dwellinuadditions,manufactured homes,man actured'n c <br /> home additions, and bunkho ses. * C� ) �,� { A:4 is 4 O� <br /> ti to e - all 5 -� 4L%J a �Ph� - k t.ds l a 111�-� '� <br /> �� 'J�" '"'" /tabiTK7s A Fee Rec: J� <br /> ifi" G e. 3 ry . NolA VI?) I)-a- <br /> V� 5 �' �n �� , Check#.5t <br /> I/ T-- y <br /> Date of staff site visit: 1,D l 3 1HL Initialsf site v' s f: ' �1 <br /> / z <br /> APPROVED BY LAND SERVICES OFFICIAL:Qi° <br /> r `` <br /> DATE: i I i I as CA <br /> a <br /> RI <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF m g a N <br /> C) C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z m N <br /> Page l of 5 N C <br /> Burnett County, WI Land Use Application—Rev 05/2022 < m , <br /> ri <br /> O <br /> z <br />