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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> A licant Com lete All Sections Below This Line 0 c <br /> PP P o rp a W <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> 6 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 D o <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `t. <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150k , <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n (....— <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 a <br /> Filling/Grading $150 Boathouse $500 c„ <br /> Permit Extension(1 Year Extension-Allowed Once) $100 < =. <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. C <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r' g <br /> *Items not fisted above will be treated as accessory structures,such as:pergolas,landscaping,etc. I I— z <br /> Property Owner's Name: �701/ (4L n0'/4( h'L��/C� /`, o , ' <br /> o <br /> Q n� -00. <br /> Property Owner's Mailing Address: 2 b 73 6 6�T %3( 4 �f e- . <br /> City / fate �Z' ii 0 <br /> Property Site Address: �� �����/J, /sC JYl � <br /> ? � / r I <br /> Contact's Telephone Number: 7J5- gig ,03/ d <br /> Contact's Email: Join ,4zi' i 6/y/oL ' oe <br /> CICi <br /> g DescriptionProperty: /075 i er set-,0f�ble f1DD. Seysew ,40F/ . <br /> Legal of Pro e <br /> TQ i R. <br /> Section#: J 3 Town#: �0 N Range#: ) 5 W Town of: 0./ GU-S 0/) n <br /> 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy offtthe deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 1/` v .7 th 7373 - <br /> Proposed Use of Structure/Addition: 694992-- <br /> Anticipated Start Date:ATF (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <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 �-t !-- '''*-j1 <br /> home additions,and bunk/�'! uses.i. <br /> I Y For h,4�vta/I 1 �:h�'or) <br /> Na .3 <br /> 2 <br /> v5 <br /> Date of staff site visit: v1?9 /' 3 Initials f site vis' staff:4 a Fee Rec: <br /> ✓ Check ti: : <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE/N/15/4?-3 < l ) <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF arfi <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z co <br /> ;` v o <br /> o <br /> Page 1 of 5 m w <br /> Burnett County,WI Land Use Application—Rev 12/2021 < Ind <br /> rr, 3 c.a <br /> ✓ a. <br /> -3 C31 <br /> a <br />