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LAND USE PERMIT APPLICATION—Burnett County, WI E g <br /> Applicant Complete All Sections Below This Line V' <br /> Pe ,' esJ ' <br /> t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial7Industrial Strut urn�e $300 Addition/Alteration to Commercial/Industrial Structure $200 ` o <br /> rucu arage Addition/Alteration to Accessory Structure $150 a <br /> CD <br /> Accessory Structure(Commercial/Industrial)^$200 X 'Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o R <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 k <br /> w <br /> *NOTE:After-the-factpermits q begun)mayup(permit a ui red after construction has be un cost to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r @ t, <br /> o , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: I J < °o y„�� ' <br /> a. <br /> Property Owner's Mailing Address: / 6 L ‘37a)/ 4/ .t:, <br /> 0; sY% F 2 <br /> k�c�Yh'c /City / , State Zip <br /> Property Site Address: (Xn$ J d 1 /'. W t : e <br /> p 915�- �4/ - ly�Cg <br /> Contact's Telephone Number: oo <br /> Contact's Email: r( y J��,� ritki k7 <br /> / 01XJ2_COM <br /> 0 00 <br /> Legal Description of Property: CDi"3 CSNI /It r%' CYij )( I JZ) (raY /q ) <br /> q U <br /> Section#: 2 Town#: �I N Range#: 1 5.- W Town of: �t,,,��5 � h:.... �j <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): ZIS`I T p <br /> Proposed Use of Structure/A itio : /7cv3 ¢ co/ k 7 caie_ 64..voic - o <br /> Anticipated Start Date: - - Z (Home/Cabin;Commercial Business'Bedroom Deck; •tc.) H <br /> Building Contractor: Sewer Installer:(/'y Ja _ <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 fr om them prior to <br /> ANY construction taking place,for any dwellings,dowelling additions.mann uctured homes,manufactured V <br /> home additions, and hankhous rs.**� Q VE.40.e4V0145k� ' c /neteu1 Oif 44(AW <br /> itp <br /> 1ee�-A- 4 It 5e� �+-�"� 10- <br /> G� b�f66�' no-}-- c..e�d 3beclieems Per' ,o <br /> n Fee Rec 7' <br /> .; -a i36 All -Vitt o ogw� ,, Check#:l t T�7c <br /> t/11.u$� I1�- o <br /> Ate of staff site visit: 11 /CI'? Initials of site vis701, K T'k+ (�►%1l ;) ei,ret cd1 Se - 4/ t l?-1 //a-a- z <br /> lcAPPROVED BY LAND SERVIC S OFFICIAL: DATE:1 1!R/?. z <br /> .1)/ - Btl. a <br /> UPON APPROVAL: APPLICANT UST POST COPY OFf. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 <br /> piLe, ?et/A+ is et/ , 17r 4,2 awe/it . r .. _ `a <br /> Page 1 of 5 © u <br /> Burnett County, WI Land Use Application —Rev 05/2022 < 114 R <br /> rn . <br /> ° <br /> cn <br /> a I <br /> 5 <br />