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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> m <br /> Applicant Complete All Sections Below This Line o N <br /> Permit Types and Fees:(Please,check appropriate boxes) A a' <br /> , ^ <br /> m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v 6.-- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 kiQ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 U 3 <br /> \ SI <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 S p <br /> Filling/Grading $150 Boathouse $500 .. <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) _$100 I' -.P'-, <br /> 4 <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. E. 1. <br /> *Items not listed above will be treated as accessory <br /> y1structures,such`as:pergolas,landscaping,etc. c p <br /> Property Owner's Name: �e- \ d-- ill_ti fides 1"-r}i-1 11.Pr fl- f <br /> '9.-- <br /> Pro Owner's Mailing Address: 1 Z �o 1 1"\N ' �' <br /> PAY g tG'�1 �C(,��� �� �i+v i�'b t S�I� ! � �. 3 <br /> City State Zip < <br /> Property Site Address: 1 .S 2_ 9\e r3 d ei r i r \ . .D ctvi Out i _f_1 3 S ° ET <br /> Contact's Telephone Number: 2-1. 3 k . CU_ 3'-4 Q <br /> Contact's Email: 2 /(lax-- k--' CA n1 Al 1.C on-\ <br /> o °� <br /> _ S. <br /> Legal Description of Property: I--0-T 3 (�1 SS z 9 1 e..3 ri.e..-1 i"i ev <br /> c. <br /> ao <br /> Section#: Town#:-1-( N Range#: 1(.. W Town of SrJ i SS 4 <br /> '- <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): " = CAI 0 P <br /> Proposed Use of Structure/Addition: r o 0) v <br /> Anticipated Start Date: - - (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-3 <br /> Building Contractor: ' — 1 Sewer Installer: = )k,ri s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 C' -0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if u permit is needed from them prior to 'O <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouse'.** <br /> Othe-6-1- a (1 Se-i-beL e ,s permit rS -;✓ - fer 4+ , �4c�(S <br /> i4 - <br /> 4,,,, W0."� C1101c1,115114 leec(S 4�} k 0 /r {iJ11�� it s �' 5 Fee Rec:J�_' <br /> i ,..at/1•f-+ K4 rnee� to ;d2. S Otcm ' 1- 4 /— 4 Check#: i 1 <br /> C�Q� rc WMi) }� r e/l�. ScA <br /> Date of staff site visit: " I a,/!1 2?- Initials site visi staff: kr-'f-1 t% rn <br /> r. <br /> a. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I 2'(15( 2 '_',_^^� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> Nil <br /> s C-) C� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT A. <br /> Page 1 of 5 M <br /> A Is.) <br /> Burnett County,WI Land Use Application—Rev 05/2022 ,(lft <br /> L 4 <br />