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LAND USE PERMIT APPLICATION - Burnett County, WI ro <br /> Applicant Complete All Sections Below This Line o CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 1/X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 N <br /> Filling/Grading $150 Boathouse $500 1 1 <br /> c4 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 e. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. "ti <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. t- g. <br /> Ali <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o r <br /> Property Owner's Name: m,L --S ;e2�",K�/ (4,1 b 1 <br /> Property Owner's Mailing Address: �9 C ' 7 C (I l L S 2.44 (20 OTC ''i Ei n <br /> City State Ilia Z t? <br /> Property Site Address: �j t 4- 4, c I <br /> O <br /> Contact's Telephone Number: S 7 0 d <br /> Contact's Email: d,,7s (L t= 7Z /V (z.i - No(2-1-7.1.C 0- N b <br /> o w <br /> 0 <br /> Legal Description of Property: 5.-F6- if 7 7 )it'/Fit <br /> d <br /> /Section#: Town#: (� N Range#: ,6 W Town of: bQ kIei <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): 13 6 7? o <br /> Proposed Use of Structure/Addition: ?'?204e, ' <br /> 5 7 t7 <br /> Anticipated Start Date: 4 5. t , j7. (Home/Cabin;Commercial Business;Bedroom;Q Deck;etc.) '- <br /> Building ContractorX a. iR-94" CS/69(d Sewer Installer: //f, rk <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 /> Awl- all tba <br /> 0fVo+ �( h�,rn a <br /> broil s FeeRec: la- <br /> Check#: 90_7 <br /> L I ^^�� d <br /> Date of staff site visit: )) 1'J/ )-i? Initials o site vis' staff: PL m <br /> , it <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: i i I J71-? ,:i ��NO <br /> UPON APPROVAL: APPLICANT UST POST COPY OF W <br /> ON <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c ' <br /> as< NJ <br /> Page 1of5 m ffill <br /> Burnett County, WI Land Use Application—Rev 05/2022 '^ <br />