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• <br /> J • , <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> • ., N <br /> Applicant Complete All Sections Below This Line 7 tJ <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) 2 6- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Z <br /> �y Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <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 ° U (. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r k) <br /> n <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> 11) <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <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. r-o g t, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 1 <br /> kA <br /> Property Owner's Name: ,u f1 God Vet IA( SI n. <br /> v <br /> nnpk <br /> Property Owner's Mailing Address: i vtf io A vOSeV II e µ J • c <br /> City State Zip <br /> Property Site Address: LO+ I ilifit ed . ::)r <br /> Contact's Telephone Number: -1f0 3- 15 0-tf 4 oq d <br /> Contact's Email: 166 051 CD <br /> S�1 141A @ 1,W'h kel 1 1 • (Imp oN o� .. <br /> Legal Description of Property: L c-f- ( (_s5 Pn 5-6 fo i '/2,3 ro 2-(0 clip\ <br /> d <br /> Section#: 1 L( Town#: 3 q N Range#: 1/ W Town of: LI✓1 C DI✓1 a <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): 3 c-81-i 0 . o <br /> +dra g� V Proposed Use of Structure/Addition: S 0 <br /> Anticipated Start Date: Dec. 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-1 L. o 1 <br /> Building Contractor: Sewer Installer: kfi <br /> ....„ <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 Y <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured hoj'tes,manufactured <br /> home additions,and bunk uses ** 5k .ces/ 0.t {/►ti44—i, <br /> 6 <br /> �' N. � bt�T�'7�� J't 4✓ � Fee Rec: SC�� <br /> Not �a. yQQt4 .� <br /> a L1 5a ctx,1 $; Re A 54 b,1 t <br /> 43; au✓ e/ Yy� Check#: C'_sA, <br /> rn <br /> Date of staff site visit: L` 12-r a a Initials of ite visit staff 1` / v i m (:� <br /> c_.:J <br /> z <br /> y11 C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1 I/? 2 L <br /> UPON APPROVAL: APPLICANT UST POST COPY OF l b° L_' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Irffil <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 05/2022 .irgil <br /> .J v <br /> i <br />