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LAND USE PERMIT APPLICATION - Burnett County, WI E.c <br /> Applicant Complete All Sections Below This Line c X. W <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) ;, d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 , <br /> Q <br /> kAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a <br /> r c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 , 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> Filling/Grading $150 Boathouse $500 i <br /> v' <br /> 11) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ?. <br /> y <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 1-1' 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: , / frk--)7 6o(25/&/ <br /> a It <br /> Property Owner's Mailing Address: <br /> i37o/ pal,, ,�� � /G Y /�y� �,� n <br /> ZV <br /> E (!1 <br /> Property Site Address: g`O 'a 'l * �� !h, <br /> Y �1)+jl WI 5g 50' /City' o G `► <br /> /� , c. <br /> (U Contact's Telephone Number: S7—2-4"v - 97g d <br /> Contact's Email: <br /> '90 rsAi E i c o cid. CO.r7 csz, <br /> Legal Description of Property: ec4 `0 7�5 C-�7 5 G$ ss' C. 01 le8ot./ <br /> / <br /> Section#: / Town#: Q N Range#: /4, W Town of: d ia---'K d g <br /> a <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): <br /> / ,i& 7AV H <br /> Proposed Use of Structure/Addition: d <br /> Anticipated Start Date: /eh Z Z ome/Cabin;Commercial Business;Bedroom;Deck;etc.) H _ <br /> Building Contractor: Jjde✓'5::74 C0,761rIroho1Tewer Installer:in-)C_4(k..- 6--• <br /> r-- <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 p,J <br /> ANY construction taking place for any dwellings,dwellin additions,manufactured homes, manufactured '� <br /> home additions, and bunkhouses.** ( I'iA. IyW1 6 1.4)3 idlteAl a5rec/vie,it- <br /> Mee4 au 5e` `G`�`S e€I 3 bei�''s S41Ii-?2--i 9S <br /> DNte �� n 7� � ,l Fee Rec:'17��[�— <br /> (GjLo� fa S be �,� �D/nb � W�� , GSm V '///�`I Check#: 957 <br /> I <br /> Date of staff site visit: l D/ Initial of site visit staff: I—. y <br /> u <br /> r <br /> z <br /> I v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5/ I(I Q <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ' a OW <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 321.GI <br /> N fit <br /> Page 1of5 -33 <br /> Burnett County, WI Land Use Application—Rev 05/2022 3'` N <br /> m o Ifiii <br /> O <br /> ti — <br /> a C 3 <br />