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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> n d L Applicant Complete All Sections Below This Line N <br /> a 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) N <br /> d D <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 I <br /> Accessory Structure(Garage,Shed,etc.) /$150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G. <br /> j\*1 CD1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures 1 $125 ,WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> _Solar Panels(Stand alone or roof mounted) $150 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. cp ,+ <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. go . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> `---. <br /> •Property Owner's Name: / I Ai -l�Ai AQ,d.. Re,,, iav h tJc 7 . '�. <br /> / t <br /> Q , <br /> Property Owner's Mailing Address: / 7J S n205.5 7 O#t) �1.�` v <br /> t City State Zip <br /> Property Site Address:/07 �,1.05 �� / n ge 6w / ‘5115-9 • a <br /> Contact's Telephone Number: 637- 4'05 S,3f Z r- d tt <br /> CD <br /> Contact's Email: �^'I,1tQ-d 42e4-400-1/0,-5 . C.z, <br /> o 00 <br /> Legal Description of Property: L 4 71. I C S b?4' V,7 Pi d Ou71 Zae `J 6g w o <br /> g <br /> Section#: '1---"5--- Town#: D Z N Range#: /8 W Town of: d eJo Pd i t JiA- N <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy <br /> of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3 Z'e-3 -3 H <br /> Proposed Use of Structure/Addition: 64A 9 Ul <br /> 5 <br /> Anticipated Start Date: ? AiG*t./ d#— it /9 t/ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: 64.y t) y/g i,..4 Sewer Installer: Cr` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY h <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <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 1•. <br /> home additions,and bunkhouses.** <br /> I4ee4 Sl1 5e,- )tic, <br /> i4,4614 4 a ,r4,41 v'' <br /> Fee Rec: <br /> ,3 I ',1 l?,�-f lc)-t- 9, +0 be_ Lo/h b;44 t/i5 ceA e $urn e rki 4 p pi is123 Check#: <br /> Date of staff site visit: 1 l /q//') Initials Qf site visi ,sf ff: I4 L <br /> m <br /> O <br /> APPROVED BY LAND SERVICES OFFICIAL:�I� �' DATE: (d15/22 a _ r— -� <br /> r <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF m W p Uuu <br /> < 3 . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o y ,� tl lrt <br /> Page 1 of 5 m ,< " <br /> Burnett County, WI Land Use Application—Rev 05/2022 < 0 Ili <br /> (I, JJ <br /> a <br />