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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 <br /> 0 ,W <br /> Permit Types and Fees:(Please,check appropriate boxes) , 0.d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 "� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 N.. O <br /> X Accessory Structur((GaraShed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure`(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C N <br /> $250 ° <br /> < <br /> Dec:k/Stairs/Patio/RetainingWalI/Sidewalk Bunkhouse 4.1 "1\.- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 — F k <br /> , ..11\-- <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. c <br /> Cb <br /> Property Owner's Name: STUART + ?AM'EC—iN OL501J $ <br /> b <br /> Property Owner's Mailing Address: (44(a IL—LTC)? RI), SHELL LAKE . W I 54' 7( ° E <br /> City State Zip < o <br /> Property Site Address: S AME AS A OVE' 7 <br /> i <br /> Contact's Telephone Number: '7-1�, -4( --2 is T d <br /> Contact's Email: s z-oA s o' . .1 cloud• Cows N b <br /> 0 00 <br /> Legal Description of Property: S E S E tro <br /> E <br /> C7 <br /> Section#: 3 5 Town#: 3 0 N Range#: l 4 W Town of: DE.W C Y . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> cn <br /> Tax ID#(1-5 digit number;found on tax statement): 3/o 6 1 . W <br /> Proposed Use of Structure/Addition: C M AG 6. Q'\ d <br /> Anticipated Start Date: 5 P(ZING (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) '-3 <br /> 2.1c23 <br /> Building Contractor: N err DE LLD E D. Sewer Installer: N/q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (a <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,'� and bunkhouses* <br /> i ee.- Q 11 a'Ji'`3.1.c ,,,1 <br /> Nva---�or ht.vKaK a0 t1('v , c 5 ,� FeeReU/J1C55 a '� i. çi'iGd I• Check#: /// <br /> c. <br /> Date of staff site visit: 1110 173 Initials If site visit staff:HE tkr r <br /> APPROVED BY LAND SERVICES OFFICIAL:, , / - DATE: I 1�� r c ` <br /> < v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 11 m W n 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 N v 0 C <br /> CI <br /> CI <br /> 4 -8 <br /> Pagelof5 A m `o <br /> U IN <br /> Burnett County,WI Land Use Application—Rev 05/2022 < ' �` JJ <br /> d <br />