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` LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> i <br /> _ Applicant Complete All Sections Below This Line 0 c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 N O <br /> j? Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 .� 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G'' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o p <br /> Filling/Grading $150 Boathouse $500 r E. <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 7 <br /> li <br /> *NOTE:After-the-fact permits(permit aquired 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 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. oz <br /> Property Owner's Name ,-jf� e.4/ el e/.4c - • <br /> Property Owner's Mailing Addres : � �5 ih���,rrssr a_� �1 X.I1 i 5-pt <br /> City State Zip < <br /> Property Site Address: / ' t t - r / ° <br /> a <br /> Contact's Telephone Number: '`?/ 3—'_ O - j o <br /> Contact's Email:, 70„‹.-r,c,2 (3c4i2 6)74....1, l'i,y-v N b .. <br /> a CM <br /> Legal Description of Property: )(/ ' Alcrz <br /> Section#:, 3 " Town#: 2 N Range#:)3/ W Town of: d <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach ax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 34 b/ w o <br /> f <br /> 6 LiO'Ck. d <br /> Proposed Use of Structure/Addition:�54-� >�2_ et �l W . <br /> Anticipated Start Date: 'J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y V' t ,\ <br /> Building Contractor: �d,17 £' Sewer Installer: V" <br /> (a <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 bunkhouse .** <br /> 40(1i ee-* 4I 5c+ r <br /> icr1— .TOI kA44U4 /lt11 Il+ Fee Rec:1,t_ <br /> Check#: /L' <br /> cn <br /> --- 0 <br /> Date of staff site visit: 1 .1 6 I?'2 Initials of ite visit staff: � 4. J <br /> ...__Jr <br /> APPROVED BY LAND SERVICES OFFICIAL: . - ��' DATE: 1�/7/? ? . -p". --1 , <br /> 1ii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t c r; lc <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rn' <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 05/2022 E' : 4 i1' <br /> a <br /> 3 <br /> b <br />