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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> 0 <br /> e b <br /> Applicant Complete All Sections Below This Line I N <br /> Permit Types and Fees:(Please,check appropriate boxes) _Q <br /> l� Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V _/. <br /> \Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,--o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 6Q F <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 : <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °<, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 Scb <br /> Filling/Grading $150 Boathouse $500 — <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I 4_ <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. (7 ? <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. <br /> Property Owner's Name: VU e�hnt , Dl�2'/! 6 0 '� <br /> Property Owner's Mailing Address: Ca-7 /(-1? Z.-11.) 0 L I-J si 1.44 k viwvl SY3°CI e' Klb <br /> City State Zip <br /> Property Site Address: 63.4,S'" /1/¢ c,t,v/.-Z -E (,..J/r�y '' 3 g C <br /> Contact's Telephone Number: 6e IZ - 7/ in qa <br /> ��� U i> , <br /> 00 <br /> Contact's Email: Ju-ed A-vtc I t (0 1 cC 04Ju , C.o— <br /> Legal Description of Property: O'1_03 _ - Of-1(r,- 1 3 _S- l S U o�( - O a�(00s. <br /> Section#: /3 Town#: /y N Range#: , W Town of: S C_ )i 'S C "• ( � <br /> S. NI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> . <br /> Tax ID#(1-5 digit number;found on tax statement): 3 ,rj,P. C,/ c <br /> Proposed Use of Structure/Addition: 6 4Z4/Lj ,d-104 . d <br /> Anticipated Start Date: _2 (H me/Cabin;Commercial Business;Bedroom;Deck:etc.) -a U.. . <br /> Building Contractor: `me Sewer Installer: /2055 70 /w dr - c�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 needy to contact their t;UC'Inspector to determine if a permit is needed from them prior to '° <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes.ntunufuctured <br /> ,-- <br /> Ito e additions,and hnnkhou 8.'':' <br /> I .e� a 11 s ‘,‘�t,5 / s Sin/- a _96Fee <br /> --lu ��- }� e�Ceec' 3 b &6% ✓8,91 f� _/ 12-1 i i Z3 Fee Rec: <br /> y <br /> C� V Check#:5 32,Z� � k� o <br /> Date of staff site visit: 1 I /�8i itials of si visit staff• m <br /> r <br /> z <br /> III)2 /2 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: i a <br /> UPON APPROVAL: APPLICANT ST POST COPY OFFi <br /> 4 6- <br /> Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z co <br /> z <br /> Page 1of5 in ^' <br /> Burnett County,WI Land Use Application—Rev 05/2022 < o M—. <br /> 2 <br /> > f <br /> 'Q . r <br />