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LAND USE PERMIT APPLICATION —Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 0 to <br /> Permit Types and Fees:(Please,check appropriate boxes) c <br /> d <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 43 O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 G\ <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 0 O <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit a qui red 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. I. P <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> -71 <br /> Property Owner's Name: L6POe P��vrl' a. <br /> Property Owner's Mailing Addres • v2 7.513 S1M N 4 S/OW& w / .s-z/t O/ F <br /> City State Zip <br /> Property Site Address: 3.c—P, )/io/') Sr: Pi IA)PR/n)C. 7Z1,J KM. sZ —__Z7a o <br /> Contact's Telephone Number: 0.2 ��9O _36a/ d <br /> ro <br /> .. <br /> Contact's Email: pf4Ff1a(oy aya A mp,cool <br /> Legal Descri ti n of Property: V I G6.) V.)- <br /> — .../.• <br /> Section#: Town#: N Range#: [ W Town of: 5co . dF <br /> *Attach additional page if needed for lengthy description OR attach—a7 copy�oof the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): ' 5 / I �� o <br /> Proposed Use of Structure/Addition: ( ffel. BR&2E 1.44Y TV f' / v d <br /> Anticipated Start Date: ,Sbeht>6 ?.O.2 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: O <br /> w � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z ,D <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 bunkhou es.** <br /> �ee-� a l( s vS • �D <br /> a IV --k k-.41 ad/ � Ur��v'( 1�Fee Rec:7 <br /> y Check ,gelter <br /> :::::t <br /> SERVICES OFFICIAL: DATE: 12/5/X { <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF z.p w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT --'' ` <br /> o0 <br /> Page 1 of 5 �ra D <br /> Burnett County, WI Land Use Application-Rev 05/2022 ri Y `"''" <br /> x <br />