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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> , N <br /> Applicant Complete All Sections Below This Line L <br /> a N <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 Dwelling/Principal Structure $300 )( Addition/Alteration to Dwelling/Principal Structure $200 I _ I <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ti O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1l— ^Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 C— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N 0 <br /> Filling/Grading $150 Boathouse $500cn ? <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 93 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a <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 E._ <br /> .ri <br /> Property Owner's Name: )(A.,\. CAc( 3ck\i!\'1 Z.v'Z n <br /> Property Owner's Mailing Address: 36kC" -4&' - le`c \At ioliN S 173 B. Z1 <br /> City) State Zip < <br /> Property Site Address: .9? 7& D\A iv\. jRa • E. <br /> Contact's Telephone Number: 6 l -c(CjO-?7c-.{3 d Ill <br /> Contact's <br /> f� <br /> Contact's Email: C�. .C\CX-vA FA.% C S '� 0--—4.-- f--CeS�r✓it_+ lxk 91e:541�i 4P o0 <br /> Legal Description of Property: 0 7+C?9-le-)s qC-tgr_14H-5 c5-Cci)-.ci5 '( ) = <br /> aa w <br /> oSib <br /> Section#: ICf Town#: TUO N Range#: (t-( W Town of: .lt.f,�^ 3. <br /> o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): I 946: E <br /> Proposed Use of Structure/Addition: e7C(1)wA 9---' C7 <br /> Anticipated Start Date: L(--l , 1t 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^1 <br /> Building Contractor: Sewer Installer: ,t- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d <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 r <br /> home additions, and bunkhouses.** T <br /> me A all S�c A. �a�"tiS per SA�V�- 1al68 <br /> Owen,, ,poi- �,--e__rc__ce4 3 b ed Fee Rec: a Cd5 <br /> L 4 441 .5 /mil oil C G i r/›.3 Check#: 6G98 <br /> . <br /> Date of staff site visit: II Idr I'?*01. Initials site visi y Al t kl--' `r- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I 'I 11'l d` < (�� <br /> UPON APPROVAL: APPLICAN ' UST POST COPY OF cCD c <br /> n CO <br /> _u r.. U <br /> SIGNET) PERMIT APPLICATION IN PLAIN SIGHT o o `�' <br /> �� Q <br /> Pagelof5 g = jll <br /> Burnett County, WI Land Use Application—Rev 05/2022 5 JJ <br /> .j <br /> a <br /> 3 <br />