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LAND USE PERMIT APPLICATION — Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line o N <br /> CI. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 TT O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0R3 g:1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> )c, Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 1.1 <br /> Property Owner's Name: r) ►1 L Vo n. <br /> Property Owner's Mailing Address: A q 5(4 le-Cl w l l t) Dan bur Li 0 I S 2 30 <br /> n Q_, _] L f City State Zip <br /> E <br /> Property Site Address: (A rJ t`o l, f) CI j() i rl C(e_ ) �ec do ii LU l�f � I 5 L(2 3 0 0 a <br /> Contact's Telephone Number: "7I . — 7 1 — U 7 7 0 tJ d <br /> (� 1 ... <br /> a. <br /> Contact's Email: e r 1/\`C D$. 10(4), out) t`C o - /J N b <br /> Legal Description of Property: <)5 / *_C\ t,61 h ' C+• /t leC1 tit/ll1 A8" A 40 k)tya9� N. CPZ <br /> D V, 1td4 e d <br /> Section#: Town#: N Range#: W own of: ...l o, <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): ra <br /> g 17 <br /> p .�' S0I &r Pa)dIs ° d <br /> Proposed Use of Structure/Ad�on: . <br /> Anticipated Start Date: // ///c2,a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: Lt,fc,ey So it T— t 1,..i-U Sewer Installer: A0, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 3 <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to 70 <br /> ANY construction taking place for any dwellings,dwelling additions, manufactured homes, manufactured 1-- <br /> home additions, and bunkhouses.** L1 <br /> (9111051 fieee-i- a(I 5e-[64.S5 <br /> Fee Rec: / 1. - <br /> Check#: /939 <br /> cA <br /> II I/ /?2 12/1317� 1� 4 k�Date of staff site visit: Initials o site vistttaff: r <br /> ' a <br /> e DATE: m �_`/ z <br /> APPROVED BY LAND SERVICES OFFICIAL: ta, ..a I?/1 / Sp/ A <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y 0'w <br /> vl me <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> o y �u <br /> z 0 o <br /> r o c !*., <br /> m c , C <br /> Page 1 of 5 x 3 r..," <br /> Burnett County,WI Land Use Application—Rev 05/2022 <br /> a <br /> 3 <br />