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. LAND USE PERMIT APPLICATION—Burnett County, WI 1 " <br /> < 1 'b <br /> Applicant Complete All Sections Below This Line 0 1 '4 N <br /> Permit Types and Fees:(Please,check appropriate boxes) R' <br /> -:Ty <br /> I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principalt Structure $200 `, I`V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �\ <br /> AccessoryStructure(Garage,Shed,etc.) ( �'�c { g $150 Addition/Alteration to Accessory Structure $150 I 1 <br /> !` Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 H. ---\ <br /> Driveways/&Campground Structures $125 WI State Statute59.692(1v)Structures $350 S <br /> Fillin Grading <br /> g $150 Boathouse $500 ; I� <br /> t <br /> Solar Panels(Stand alone or roof mounted) $150_ Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> ' <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 1 <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. z <br /> 0 <br /> Property Owner's Name: % y I e r' 0Itch -1 ►-> r tt, �`"r �!. 4-e <br /> o I <br /> Property Owner's Mailing Address: / 3 f 1-/ C O-' I•7 4.( , .o•n ,., L-r 3-yea I <br /> City State Zip C <br /> Property Site Address: /.?/ `f C. )1 i/ µ 3-/-vD cr ii1- 3"-- 7 P-�I ° r <br /> a <br /> Contact's Telephone Nunter: .7 /S- 1 i(, •-c J-- o <br /> Contact's Email: 0 /-c r /5-' -iiii f,'hi,'/ . 4.-6. 1r1N v <br /> t� t I ° d0 <br /> Legal Description of Property: -�- ; c� e--�cT 2 5 W ✓�WC t �X goP. <br /> Section#: 0I Town#: 3 t c� 1 N Range#: I W Town of: A ti 5 Pc <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 2 I <br /> Tax ID#(1-5 digit number,,found on tax statement): /,j 5 S 7 O o FA <br /> Proposed Use of Structure/Addition: v c..�. < g 8 <br /> Anticipated Start Date: --i(HomerCabtn:Commercial Business;Bedroom;Deck;etc.) '-i <br /> Building Contractor: "//y�re 0/1-e r Sewer Installer: /1 in t �}`� <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 z, <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> • <br /> 0 141 u s1- rne�ef- a ii s ( 10 -f.j- ;rem serh*. dra;4 G•tid) <br /> F�)►kr- .�,r L,...4 ,4.11 o4 <br /> 49 J kr�^ Iv d ude <br /> llk Pe(�k Fee Re c: � W <br /> elNeu/ db/1, � A�) Wd,Anew 5 Check#: ' <br /> ` 614 l?` ly} I21►-as aDate of staff siteisit: to( �� -, site :rl ' ki— <br /> d. <br /> • LA h <br /> APPROVED BY LAND SERVICES OFFICIAL: ro, <br /> DATE: 12 l2T l?-a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF s I n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r go C <br /> e r • <br /> Page l of 5 R r ^, <br /> Burnett County, WI Land Use Application—Rev 05/2022 < 1iiili <br /> r �� J <br />