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LAND USE PERMIT APPLICATION —Burnett County, WI . <br /> ' Applicant Complete All Sections Below This Line o c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) da <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 t <br /> 1 <br /> Commercial/Industrial Structure f $300 Addition/Alteration to Commercial/Industrial Structure $200 r--p <br /> Accessory Structure(Garage,Shed,etc.)12) Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-- , <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° p" <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2 3 <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' 1 O <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. oz <br /> 11 <br /> Property Owner's Name: al(, GrnnlywU'da4 C (Mir/M/01 00. <br /> Property Owner's Mailing Address: pp 50x. to`T , w� �orTr/l''7Z i ° <br /> ty State c <br /> Property Site Address: pf1A1 ri 4::_ b fr 54 b ° c <br /> W r i a t i- IIa4ii.C_.: (4,-,l*v,0A,e: 5.-L.,to 2- <br /> Contact's Telephone Number: ((2 - .1 V"-00 410- , <br /> d <br /> 4'fl-1ac4 Maiil'V7' 55 tt?or T"oy L•-, N, ?!„„uo.fc,, 53"-yy7 I0.3C5M V23 U <br /> Contact's Email: CXc ,,/q- 25W419�.t- cc/1. cc�-4-) ['P72 (f3g131) Nip <br /> o ao r, <br /> Legal Description of Property:51tbd1 d51WV1' Vil laT at yellow tak aw6ft plal (Poo/ $f v `h <br /> .s <br /> lirrSection#: Zo Town#: I/O N Range#: �f0 W Town of: Oak-lama � �L� <br /> E. N NM <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): '�7--�I_ -� i . rt <br /> X ree/►� d rG r\ — j 5 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: /G (Horn Cabin;Commercial Business;Bedroom;Deck;etc.) I--3 `J <br /> Building Contractor: 7EIT Sewer Installer: A//f7 O - <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z t ''' <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 bunkhouse .** T <br /> II 2 meek a(( 5e�1-�o�- ��jj.. L_ j Hof <br /> 5� v l- 2 C /� �'T' (-Ct.GG QjG ,i►llr`t,�Glm�'L' T Fee Rec: /2a 4' <br /> Co m b/1 ,ke /pecL( i 5JGY'ICC'I pofc�j a,reA . y Check#: 1.201. <br /> per, <br /> K be c 44 & o%3c(e.ev1,5 <br /> to of staff site visit: 9 /?a- Initials f site visi t /1 Z. rn <br /> m <br /> r <br /> a , <br /> z <br /> Q I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I(g l a a r <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF m5. 03 n 0 <br /> .. 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo L <br /> Pagelof5 s ' - <br /> Hil <br /> Burnett County, WI Land Use Application—Rev 05/2022 < a <br /> rn <br /> --3 <br /> a <br /> 3 <br />