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LAND USE PERMIT APPLICATION— Burnett County, WI• <br /> Applicant Complete All Sections Below This Line g' <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> \ C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> JAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 '\ <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> .. b) k-- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t— <br /> o <br /> Filling/Grading $150 Boathouse $500 443 <br /> v. <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> a <br /> *NOTE:After-the-factpermits q begun)mayup <br /> (permit a ui red after construction has b un cost to three times the normal fee. -0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g• I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 41 <br /> o Tl <br /> -�- f rProperty Owner's Name: �.1 Q t' Z `5 O i,iJ e.r 5 °o 1/4 <br /> Property Owner's Mailing Address:0) 3(o.a (�1 .ck 6:co lc- Re9 , `-) y)„er- (,) 1 5-9go/ <br /> J City State Zi <br /> Property Site Address:i 3(� i61 e C k 6r 4,>c re- Rd . 3Mn n e r I $�j/(0/ 0 I <br /> Contact's Telephone Number: t � <br /> p �i s— yC� — a 5 '7 z ,� d <br /> Contact's Email: j2c-44)p&erS 12OC hOTni tr /. CO1-71 <br /> 0 cm <br /> Legal Description of Property:]? 2/ 7-1 ,3 7 g ) Li SU.I /Ai 1,t1 5E Ex C5/r( V r T' /bl o <br /> • <br /> Section#: a,tTown#: 3 q N Range#: 111 W Town of: R U 5 K a <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): /(p(162 //6i) , <br /> 7o <br /> Proposed Use of Structure/Addition: Go.(a � Cj <br /> Anticipated Start Date: -- i glow/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> Building Contractor: A 1l 5.0__-\k Sewer Installer: E <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 p° <br /> ANY construction taking place for any dwellings,dwelling addi 'ons,manufa ured homes,manufactured <br /> home additions,and bunkhouses.** 0 ;5 , ,wctw�- ;5 Y1ad,., .a.r, '. <br /> eitla5A- y ice-- a.1i SeI'I� ,It-S b,...5;ites5 05-eNo f -6( �, en-ct h II st b,-r-6) ,,„,_ t 51 e ' Fee Rec: �/ <br /> �s.blt �/ y Check#: 35S <br /> II �o�e Cwncr is r�s� 5�dlC <br /> Date of staff site visit:3/p2 71 �3 Initials of site visit staff: jd) Stri <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:31?S 42-3 ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i fiii <br /> �W 3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ds <br /> $.g, N <br /> o ifirg <br /> (-1'' , <br /> Page l of 5 c c <br /> Burnett County,WI Land Use Application—Rev 05/2022 w �! <br /> 2. <br />