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LAND USE PERMIT APPLICATION —Burnett County, WI a 5 L.;" <br /> N <br /> Applicant Complete All Sections Below This Line 0 vs <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> $300))) 5 0`� <br /> X Dwelling/Principal Structure $30 ^ Addition/Alteration to Dwelling/Principal Structure $200 r�, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -1' ` G <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> CY <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> W r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C. o <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 7 - ? („► <br /> �70 s <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 . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. — ..4. <br /> Property Owner's Name: (A j)((13v" '( \3vN)-QS" a. <br /> Er <br /> Property Owner's Mailing Address: (1 (44 -- 5 z , LIS L ti C�< � N8S 3 5. n Ili_ City J State Zip 7 <br /> Property Site Address: r 1 Z I t S Vol/ co,C ' c (2c,--i Dr 1 S(1 •5, (K' ( C' S 1 -'. o <br /> a. <br /> Contact's Telephone Number: 3 i I 7 S z -Z2.S-7 d <br /> CD <br /> Contact's Email: GU �t(S 106.) J mac) ef C�iV1 c S�' 11 et ` 1 �, 0 <br /> Legal Description of Property: 6 crz <br /> ✓(-\. 5 Z e s 0 f* c -n ci p ( 7 I- - Vl <br /> C1 <br /> Section#: Z 7 Town#: 3 N Range#: W Town of: T5- v.-E, • 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system 'ropers))page.* <br /> C4 <br /> Tax ID#(1-5 digit number;found on tax statement): Z Lt 3 S ._ o <br /> Proposed Use of Structure/Addition: cab , ,,) 731 NI d <br /> Anticipated Start Date: - 4 - Z.Z- (Home/Cabin;Commercial Business;Bedroom; <br /> -Deck;etc.) -i ^ <br /> �U" S ✓l o t \v <br /> Building Contractor: S_F I� Sewer Installer: � "`"� W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY \.!J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 1..0A <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 bunkhouses.** N \\\ <br /> ()Follow a1! coitcG'4revtS ," . VMA• 2 3 -D/. <br /> r)sfv'uGfutit- LA)a 5 c-4,IAA?f`� `^y VE.Id ?Alt GoNTaG7� l.1U C, �tSiDe Fee Rec:�C)(-)42 <br /> - t^ �eA'✓` p e-v LAA / -i-, Cheek#: .1 <br /> Date of staff site visit: g/ I/ ZZ' Initials of site visit staff: ,7: D <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓/0ot.3 1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i 1 ,_ Ell'l l <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , ' r- V1� ' <br /> 2. N <br /> RAI <br /> ,,,110 (uunIA1Nq allowed 01' clout ro�e-v' f.�vw"l'f-. 0 Q Co MI <br /> /V r / / _ may,Wi l,% ' Page 1 of 5 �, C4 <br /> CIj(Sl� qh G�f�''r'"'eBurnett County, WI Land Use Application-Rev 05/2022 t Iiiril <br />