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. - LAND USE PERMIT APPLICATION - Burnett County, WI L <br /> FApplicant Complete All Sections Below This Line c W <br /> a. <br /> Permif Types and Fees:(Please,check appropriate boxes) <br /> C7 ti <br /> ti <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300_ Addition/Alteration to Commercial/Industrial Structure $200 O <br /> )—.X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> e : <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $25t1 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o d <br /> VI t <br /> Filling/Grading $150 Boathouse $500 i <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2 I, <br /> *NOTE:After-the-fact permits(permit a qui red after construction has begun)may cost up to three times the normal fee. a <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. z Ib <br /> Property Owner's Name: / Gl;i-¢/le r Y. fr tit.reen/%v ile �� o �T <br /> jJ� —41Ri E <br /> Property Owner's Mailing Address: �s�'Jf.V d� '7���/ ��Are) > r PJ�' ° `i . <br /> City State Zip <br /> Property Site Address: Lif 43 pay f' pki S,'rtvt` fur 4-41 °7d q . ° c i v <br /> Contact's Telephone Number: LQ/o2 ' 74 — 6 f/ (4 t� )0 Q\ d <br /> Contact's Email: cl r rph h t (id,.. 7 VV Q 0 /mac ik.()d r". �,Q9, o <br /> Legal Description of Property: I/??3 / 406.R'e kD, — ,Co-/- (2c -t it-y5'S"/L fc, <br /> d <br /> Section#: / Town#: 38 N Range#: / W Town of: im C_'�v //��-e 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c2" <br /> Tax ID#(1-5 digit number;found on tax statement): 3 Vo 7je2) i <br /> '')1..)1. l' <br /> Proposed Use of Structure/Addition: 41 ,�,„�,ur1yy t2al9C Q "/"." P, ..it e_ '?el ie✓\ <br /> Anticipated Start Date: —/0 - 2 (Home/Cabin; ommercial Busm• am,.. ;g etc. <br /> Building Contractor: Se l'F Sewer Installer: r M CG <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 pci <br /> ANY construction taking place for any dwellin s,dwelling additions,manufactured homes,manufactured --- <br /> home additions, and bunkhouses.** AV 5} c e- (Deck t for .e}C) o ( \ aI`/ <br /> l0 Mee-1— al( 5e 5 loos?.i# p t�. 67µ'�a a l" "'k O <br /> f sI1t�r� at`C TLC /�A I� AAVI � R i(� <br /> 10 �Z /✓1 "_ L Fee Rec: Wit,-I <br /> or pf. needs k'i" ` p brry 5.cAi telp pe,%u.f-be LOI/1 3 „ Check#: NSW— <br /> �/ J r_ I'�i/ v <br /> Date of sta site visit: 6 �3/�� Initial of site v' it staff: +'►1 <br /> r <br /> a <br /> z <br /> C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: yl2l423 �, <br /> L <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF n c rNM <br /> (Dcn <br /> � z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <° -- <br /> z . 0 cs <br /> { ac r <br /> Page l of 5 14,E . <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> cA <br /> > �I <br /> -o <br />