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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI cr <br /> Applicant Complete All Sections Below This Line E w <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> O � <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 V (W <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 $15000 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 F <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r '444:* <br /> 9. <br /> Filling/Grading $150 Boathouse $500 lb <br /> Lip r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> r <br /> *NOTE:After-the-fact permits (permit aquired after construction has begun)may cost up to three times the normal fee. p <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. or 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> �n 1' ► 0 <br /> Property Owner's Name: L f V IS u <br /> ' 2g21 .Fv c'k �Zci ,� w 1 9- g 3 0 = w <br /> Property Owner's Mailing Address: c <br /> Property Site Address: 2%25 T�e n Ch t ck D � City \ <br /> State 3 Zip o 0 <br /> _ <br /> Contact's Telephone Number: —115- rj 2/t)'0-1 35 UJ d <br /> Contact's Email: _s(6)6 0\S on1-6 9vnnw+1. CD rn N ro •-C. <br /> Legal Description of Property: Sou(444,e044- uav--4-effot 7Vw ►V ot- ` S� 5. <br /> � 0.Section#: 2-0 Town#: qD N Range#: I(Q W Town of: Oa,lI,�-f/ 1 <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): 131114 i ' <br /> Proposed Use of Structure/Addit'on: W( o 6 (� C7 <br /> Anticipated Start Date: r;{ 0 l 2- (Home/Cabin;Commercial Business;Bedroom;Deck;etc. <br /> Building Contractor: l '. Sewer Installer: k/` `'� � "'� <br /> S — t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY U1 <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 /> e mee4 a 5c+ix 544v-33-I L{ y <br /> O III A04- 3 beA/ ?S �;vtS�+�� (GIIiG t d�Gl►tC�c., Fee Rec: C C-C'` <br /> r,n,+ is Aeeel aIlo� <br /> � j v/1y U 11 Check#:�5 <br /> 1 4 feSd�e/tii �1 • L o <br /> Date of staff site visit: i d 117/v or Initials of site visit staff: T ii <br /> z <br /> • a <br /> APPROVED BY LAND SERVICES OFFICIAL:C Ch DATE: ii/2.1 :3 C7 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a �, ,MI <br /> SIGNET) PERMIT APPLICATION IN PLAIN SIGHT c . <br /> rtH <br /> r (D n N <br /> '' vo <br /> Pagelof5 Tom - Q <br /> Burnett County, WI Land Use Application—Rev 05/2022 <rr - N <br /> ilijil <br /> v _cp <br /> a <br /> 3 <br /> L <br />