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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line tit1 <br /> a N <br /> w <br /> n. ' <br /> Permit Types and Fees:(Please,check appropriate boxes) d_ <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> r, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t ,414 <br /> Filling/Grading $150 Boathouse $500 IN <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w <br /> r <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. o 2. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: Mx.901 L nut V 1S 6o <br /> JJ II__ �^'^(^ �p <br /> Property Owner's Mailing Address: 2S2S 1 �V i L'Vl 6� `Y hi w l J-t$3 D i n , C' <br /> (- City J State Zip <br /> Property Site Address: 2S2�7 •T�t' ( V\ .1 Dan W \ o c <br /> a. <br /> Contact's Telephone Number: (5' 5 'l7i 35 o <br /> Contact's Email: v " J Ji 1S on 6�Wl . Lc7 t"Vt N 'v .-C <br /> �v�j ��x T 0 (1: '\ <br /> Legal Description of Property: Son b�� C u a1 r`�' ,V �r'ysf U <br /> Section#: 2, Town#:40 N Range#: r(Q W Town of: Oc k- 041 __ <br /> 0. <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): I 3"[c-f9-- f <br /> Proposed Use of Structure/Additi'on: b ed ro 6(4 V� <br /> Anticipated Start Date: I 0 I Z.2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.)) f� 1-3 1!. (35 <br /> Building Contractor: sr_ Sewer Installer:-- 1`Qj. i 4S-5'0/On — <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY l f l <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 bunkho ses.** <br /> n iktee4 kl( 5e+1)4. -�3-l�{ <br /> 0414.l!1' AG+ 4P P,hG .3 s Fee Rec: �� <br /> (•n, - is A eeel tb a Ilo� I; s1 cL4 (cti.Cite,/,d�k,e4) -, <br /> �C0�1Gt� o/l UU5� 'ct,� �C'� DID Check#: . SGg <br /> t 4 feS �ti a L o <br /> Date of staff site visit: l b 1171 v ? Initials of site visit staff: ) 1 E rn <br /> 6. 64 , <br /> APPROVED BY LAND SERVICES OFFICIAL:C¢! DATE: y/a-0 7 r---^-=J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF u7 Q �, Val <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Co a) `-- <br /> r y n N �_ <br /> Page 1 of 5 � N Q <br /> Burnett County, WI Land Use Application—Rev 05/2022 7 g N <br /> Iiiil <br /> o , <br /> a <br />