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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> cn Applicant Complete All Sections Below This Line 0 t� <br /> Permit Types and Fees:(Please,check appropriate boxes) S. c <br /> d _) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 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 /> vDeck/Stairs/Patio/Retaining Wa II/Si dewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 X WI State Statute 59.692(1v)Structures $350 o tvr 46 <br /> Filling/Grading $150 Boathouse $500 P i <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 r, <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. .I`1J <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o `` 1 <br /> Property Owner's Name: T HatAAS AWL) ELAJA1 SN r4',Cy o -- <br /> b <br /> Property Owner's Mailing Address: /7ot36 #of ExPS kPcAD EbeAl Pei4i,P r MN SS 34V 2 <br /> , <br /> City State Zip .. . <br /> Property Site Address: 2 3/?8 0 umNAM t nk E PGAD Shernl Wi 54'&)7 <br /> 0. ` ` <br /> Contact's Telephone Number: 9 5) - 6 c 7 -/6 a 7 - 0 <br /> Contact's Email: TSH/4eCF,y /959 3 m A i I . CO/.' <br /> N (ro <br /> Legal Description of Property: LOTS i C SM V i P 4, (iN t>o V &oT 4) go <br /> 0 <br /> Section#: 62) Town#: 3 ef3 N Range#: I 7 W Town of: Dai,It ci S . <br /> o r <br /> ' 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): .142 38 <br /> Proposed Use of Structure/Addition: 44441/11/1P6te STA/k'S' -To L/U ; P/2EP17/P911710 6 <br /> Anticipated Start Date: SaJ u4ykaga4 EA/SW/4-(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '- <br /> tr-- <br /> WiBuilding Contractor: l'J 'U tcok;r6rNhAt t ?cOa3arA. Sewer Installer: NI 3 <br /> gr <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z U <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to x <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured '\. <br /> home additions,and bunkhouses.**f r1 �' � 7.5-F1- S -tGk e <br /> nof <br /> 41' S e4D4 Fee Rec: i f 7 5", <br /> U old r�fi��4'0h1 rc�,�,�t,n -, <br /> P Check#: 12 0 9) <br /> 0 <br /> Date of staff site visit: I a/i 3/a rt- Initials site visit st ff: t f k7 <br /> z I —1 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 12( /?? g �^ <br /> � a 1—I <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF V <c e <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = o o G� <br /> Page l of ^§CD 0 M <br /> 511 <br /> Burnett County, WI Land Use Application-Rev 05/2022 r'-- - <br /> 1 l•--=.--0 <br /> b <br />