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b C" <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 0 N <br /> c. <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure, $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.)' -$15& Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° a ,�. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N AV <br /> Filling/Grading $150 Boathouse $500 v <br /> 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. lw <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i" •. '` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> N. 0 <br /> Property Owner's Name: Iry tt g_ <br /> . • @, 1 '3 i<-o4 . r b <br /> Property Owner's Mailing Address: Old 3 S SIV.0 ki 6_, t E <br /> t{ City State Zip o <br /> Property Site Address: a O(d 3 Sir€vi 1 �� oZ 0 <br /> -, <br /> Contact's Telephone Number: 34\ti b3) �cr'- S q 9-D PreF-fc' (a_00 41C(-D 3 r- G d <br /> Contact's Email: t hc# i r gP Kaln©rvv I vt IGS'! �C,,ti3;f Cyr✓ o trq U <br /> Legal Description of Property:5/a SW IV tC�l V t3 t C7 <br /> Section#: 3 a' Town#: 3 9 N Range#: � (v W Town of: 'r ►-e-evtW f-7 <br /> 0 <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 304 F <br /> Proposed Use of Structure/Addition: 5 ctq e S4-fS 9� 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Busin s;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 bunkhouses.** <br /> ro Nee-I- c,if 5Au ci/i , <br /> iM- - hw,n k a' 16.h v4 .3 <br /> 2 <br /> / tn <br /> Date of staff site visit:-/I.)q I??- Initial of site v'si t f: hi- Pit__ Fee Rec j1,7 <br /> v Check#: 57 Ef- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I I'I(1/9-62- Jill ,P t"`t� <br /> UPON APPROVAL: APPLICAN f MUST POST COPY OF > C3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z c co m 0 <br /> C <br /> Page l of 5 m y w <br /> tl <br /> Burnett County, WI Land Use Application—Rev 12/2021 c§ ry '_ <br /> 0" Nq fV LS <br /> 3 N <br /> gifil <br /> -I ,. <br />