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• LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5' V. ' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> aW <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 r 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a <br /> c lJ <br /> Deck/Stairs/Patio/R o� V)etaining Wall/Sidewalk Bunkhouse $250 7— <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r ct <br /> o ).1 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 6 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ' g <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Z <br /> o <br /> .71 <br /> Property Owner's Name: -bktl ky 'R. A ri d e.v-50 in <br /> I <br /> Property Owner's Mailing Address: 46 AO 13ttic.K re, Ilk 1'Fe- 1.4.5 Verb NV gl 13 4- .: <br /> 5&t T O, Zan (0$ k MN 55Gb9 City State Zip c <br /> Property Site Address: g2 c1 L79 `. f. Cr-0$ r ° '' <br /> a <br /> Contact's Telephone Number: 'I6+-150 - 2.75 g d <br /> Contact's Email: 5 btr.t ley ray I V &Y am' ' co w_-� o <br /> go <br /> Legal Description of Property:N tlr+LF OF N /MLF op SF 5 '! cm <br /> u 0 <br /> Section#: ?)1p Town#: l j N Range#: 17 W Town of: �5S <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):,6,35e N o H <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —] w <br /> Building Contractor: Sewer Installer: .� <br /> .. C.‘••: :>c)C(P) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 ILA <br /> home additions,and bunkhouses.** <br /> Ni <br /> • ,-f- w s. -f-k2 S <br /> Fee Rec: v— <br /> t\10A- -Ebr man0f'fA:H Check#: 10eR-? <br /> ch <br /> Date of staff site visit:1I2 5/23 Initials of site visit staff:%k J P <br /> RZ <br /> ,�j 7/2d <br /> APPROVED BY LAND SERVICES OFFICIAL C /v DATE: / zs �-_� <br /> < r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ,T a 111111 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o Ira <br /> p p co . <br /> Page l of 5 R N Q <br /> Burnett County, WI Land Use Application—Rev 05/2022 < g `'' M <br /> o <br /> y L` JJ <br />