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. LAND USE PERMIT APPLICATION—Burnett County, WI a to <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) ' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <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 <br /> Filling/Grading $150 Boathouse $500 � <br /> Permit Extension(1 Year Extension-Allowed Once) $100 A <br /> q <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. el <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o C' <br /> Property Owner's Name: THO M A S 4. EC 11/N F S ti I L C F/ A <br /> E. n 1 <br /> Property Owner's Mailing Address: i 70 8 6 ec 6 FRS kl?d A/a E DEN Pet;gee/E MA/ 55 3y) c <br /> City State Zip o N p <br /> Property Site Address: ,7317�', b%MAM [AkF 'cAA 4AAi'FtS iN 5ye7.� S <br /> Contact's Telephone Number: ?g) — (Po 7 AI) 7 - . d 1 <br /> Contact's Email: %Sh//RCFy /9 5 V I tg M ArI. rJ', . C Ot-I �, / o on <br /> Legal Description of Property: �07L GSA V O4 / / 'P `� b\ <br /> P. <br /> Section#: 28 Town#: 3 13 ti N Range#: i 7 W Town of: Us l Al I FL S F. <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): vZ(o 36 JO V, W <br /> Proposed Use of Structure/Addition: 6-A i('A&-6 i CARS a Sre.C'Ad F ,b d <br /> Anticipated Start Date: "1/y ;)9C a (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -3 <br /> 7 <br /> W �V <br /> Building Contractor: *7 Sewer Installer: NA <br /> 's i) S \VV_`x` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Nw <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z f..... <br /> 7:, <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 bunkhouses.** <br /> F(/orb 4// ,4s per- V,& - zZ —/6 . <br /> Of h (6 �,,,,t hog► ..;ie�c I5b <br /> q � Fee Rec: <br /> �J Check#: C -- <br /> c <br /> Date of staff site visit: IO/3'f/2o ZZ Initials of site visit staff: /9.,7 a <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: '2121/??- — t' r <br /> 7 a CM <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 70 <br /> a (o3 c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 4 o o R <br /> Page 1 of 5 5144 N <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> J <br />