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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) a C71 <br /> e 41 <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G g <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse ___ $250 0 z? <br /> Driveways/&Campground Structures $125 _ WI State Statute cq.Rco(1v)Structures. $350 \, <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 /> Ctj <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. CD <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 4o <br /> Property Owner's Name: 30 0 (--(.. k,C.J—<4 g, <br /> 0_ 1,�� <br /> Property Owner's Mailing Address: `6 1 z I°rPH /, - _ ,� I'. 6 o, /-t '`P'` i" n <br /> City State Zip c <br /> Property Site Address: 10'5, ) .T i ' 1 '1040rvi-t_thi; g-t-P ( ° 0 <br /> a. <br /> Contact's Telephone Number: iv I - 7L'f — '71 G d <br /> ` �'c� ill IJL E cusT '/ •• <br /> CD <br /> Contact's Email: S V` <br /> q N 00 <br /> Legal Description of Property:!—a , I CS/1 66 I V 0 I / u <br /> c2 .669 <br /> Iy U. <br /> Section#: \ l� Town#: 3 N Range#: 1 W Town of: V-,5 . <br /> a. <br /> 0 <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):_6741 5 " -3 H <br /> Proposed Use of Structurfe�ddi 'on: f^"'LSic6iL F C1— 9 T 0 7 <br /> Anticipated Start Date: ltJ - '' l O -7 - (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (" H <br /> �-C—yr (,�. ',It.-c�'"t M Sewer Installer: C� <br /> Building Contractor: , <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 /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to pz) <br /> I `� <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured � <br /> home additions, and bunkhouses/** <br /> Lodi) - 64 4 r5 vl Ce oil ,of t'c ' k l' 611123 <br /> ee Rec: , <br /> I 5, Check#: , '''. <br /> Date of staff site visit: `1 /7/ 7 - + i0( 2 initia s of site isit,S4af) g-j�k ''` �� _w,,._.,:_ ,: -- <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL: ( LATE:_ 6 15b3 m <br /> UPON APPROVAL: APPLICAN4IUST POST COPY OF y a` <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' c-J 6 <br /> z <br /> ©' '.•, m <br /> Page 1of5 x <br /> Burnett County, WI Land Use Application—Rev 05/2022 < -� - <br /> m CDO <br /> a <br /> 3 <br />