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• <br /> • <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> N <br /> : y <br /> Applicant Complete All Sections Below This Line 0 a ;� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 :k"---- <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 <br /> ip <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 <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 p <br /> *NOTE:After-the-fact permits(permit aqui 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. �' r.• i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c mk <br /> Property Owner's Name: G-1 di-/z°S et- �� t c't . I—/..f i ° <br /> Z 9 6 v t 21' R d P)�,4u' 5 �'�C) n F � <br /> Property Owner's Mailing Address: /� ' <br /> City State Zip <br /> Property Site Address: 541 )'1-e.— • <br /> 0 v, <br /> a <br /> Contact's Telephone Number: 6 / �1 if-- 3 i(15-- w w <br /> Contact's Email: C/l /e-S (1...c21, f6 /@ y'cI h o t/ . : G N <br /> Legal Description of Property: G Sf'1�c i L C CJ E� i � Y 4 Z 04 \ <br /> Section#: 9 Town#: 110 N Range#: /tf W Town of: SCG �/ ,7 <br /> f v <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): / 7?Cs— <br /> �xt � z. F. _ <br /> Proposed Use of Structure/Addition: , X Z Li Gf t"t' /77 t%-, --LIT) ' "f 4)-� d <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom; eck;etc.) 0-3 U . <br /> Building Contractor: T 3 J Sewer Installer: <br /> 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 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 bunkhous s.** <br /> g(vo.k_ <br /> rMeekall ��►'1µ✓�''�� a b, c�,�/1Fee Rec:_�Check#: 5�ft')2 <br /> I 2 / ']� �� e <br /> Date of staff site visit: (I /2 S ?" Initials f site visit staff: �I E 4. I\- <br /> APPROVED BY LAND SERVICES OFFICIAL: EiC (1 DATE: f 9.(p/? �-�-_� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ; aI <br /> ! <br /> me <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z W j <br /> C <br /> Page 1 of 5 m 1`a <br /> Burnett County,WI Land Use Application—Rev 05/2022 '' W g <br /> C .- <br /> i <br />