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• LAND USE PERMIT APPLICATION — Burnett County, WI cr r <br /> N. <br /> Applicant Complete All Sections Below This Line 0c 0 w <br /> ' <br /> Permit Types and Fees:(Please,check appropriate boxes) g <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Fp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Nk}1 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> /- Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << �Q <br /> T4.Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 gr. <br /> w <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 `)J <br /> *NOTE:After-the-fact permits (permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: 5 r c 0.e ar1CI 50 y, ci Y't:,... ��c3 a e 5 alp is <br /> 0, <br /> Property Owner's Mailing Address: , 6-3/1 Bearr'� 1 ) e 3 I i l p iS in'7 53-Y/V n �, <br /> � � �_ City State Zip <br /> Property Site Address: g S 9 tt)�,ca ,/7 ► a,-,r..,L. • ° c <br /> a <br /> Contact's Telephone Number: 1 - 10 9 - 3 7 '3 7) N Ci 0 <br /> Contact's Email: a 0 d i p ec c'S(i f\ j 6 ?I e) 9 tYka i / , £ O /n N ro <br /> Legal Description of Property: P�o T /1'1 S 1 0 D G C -�1 3 9 S" 3 <br /> P1 C+,S . <br /> Section#: J Town#: d <br /> G N Range#: W Town of: Cl i ✓1 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> c <br /> Tax ID#(1-5 digit number; found on tax statement): 3 f:, 0 3 4P ,-3 <br /> Proposed Use of Structure/Addition: R-e__iO t .�,e C'0,1/4.11-i c 1 b- CiC I b <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -3 <br /> Building Contractor: C i.l 5 Tc ,r.‘ f3 , l e I + 114 S Sewer Installer: <br /> ctrnd / X rit`d s \AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY '3' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured \ , ,is <br /> home additions, and bunkhouses.** V <br /> .__CO <br /> 0 l Ix ZG t pa it o i b/E. Y -i/ 1OV' . / - Fee Rec: f40 <br /> 0 t.$ D e t^Innt,� l►'1 c/u c e s Gt S t l.Ja//E bogy 7' 71e, /4/ N Check#: %C1(<�40 <br /> T / � v <br /> Date of staff site visit: J 0l3ZZ//ZO - Initials of site visit staff: "II/` , <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ?! ZT/6O 2-3 <br /> < a V> <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF y 5 j fi <br /> `. 0 t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o "' <br /> See c>!o 0.0 c - OZ i i= <br /> r 0, M .-. <br /> ylC�u�.5 /��� ►^ctJiv1� Page 1 of 5 a N <br /> Burnett County, WI Land Use Application—Rev 05/2022 -..-- -.-- <br /> m <br /> v <br /> v, <br /> m <br /> t <br />