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LAND USE PERMIT APPLICATION - Burnett County, WI L <br /> Applicant Complete All Sections Below This Line <br /> a <br /> ..at Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 7( Addition/Alteration to Dwelling/Principal Structure $200 0, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 1" <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits (permit aqui red after construction has begun)may cost up to three times the normal fee. b <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r- g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: L < h a, 4 n. `N <br /> Property Owner's Mailing Address: 36 6 Pevi ,',1 s l.t,t ck IC-LJl (th b W i Y 7 <br /> U �^� City State Zip -- . <br /> Property Site Address: 7 ! 5 PP,t irtSa.,I ek R.iJ( o <br /> 22 <br /> Fa <br /> Contact's Telephone Number: 7( ��'' /c�I— .?/,. ey ^., d <br /> Contact's Email: /te-e h rer1 ez ill QgThal, CC. tz N <br /> 3 1$)00 ✓I Plod 15c26'SLegal Description of Property ryl 0,0 <br /> '...... <br /> r <br /> Section#: 3,e Town#: 140 N Range#: W Town of: Acc C IG5 opt <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> --,z) irt, <br /> Tax ID#(1-5 digit number;found on tax statement): 6 0 q2- f " <br /> Proposed Use of Structure/Addition: K;I-C 1.,6,-, ,ff r(,-(;rcn yy/ r 0 C; ._4- ; <br /> Anticipated Start Date: 'J l I _ (Home/Cabin;Coihmercial Business;Bedroom;Deck,,etc) H - <br /> Building Contractor: 4,,elk lc <br /> A/I & 'It f,-.A, Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z V <br /> II <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to pJ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkho ses.** 0-1 <br /> I ✓)7'ce'1- et.0/ -f 4C 14.E h � Cp <br /> A0� /( . D/(T 0 v lQ- ?3 FeeRec: ,1) 004- <br /> e Sivueik e,5 I'Io, 4r h.st'Yl�U'j t'tRPr ,�a.�v/I• -3- Check#: II 6, 1 .--- <br /> Date of staff site visit: 2-1012 3 Initial of site vis' staff: U 7 l g o5 <br /> a <br /> rm �` <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE fill y/a3 m e r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m g Lci. m a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Nmzo g <br /> { a,c C <br /> Page 1 of 5 n m `'' <br /> Burnett County, WI Land Use Application—Rev 05/2022 < a �` J' <br /> m <br /> > <br /> i <br />