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VD *17 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI cr r~ <br /> b <br /> Applicant Complete All Sections Below This Line o C' N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d UI <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 y . Sz o <br /> )( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 79 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> s <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 D o <br /> Filling/Grading $150 Boathouse $500 <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. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o i C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> cF •illa <br /> Property Owner's Name: 6011?-"( 4 0 5p )cz c <br /> c.. t7g- In t <br /> Property Owner's Mailing Address: 2 IS° DV ACA• I. AvV ?-44- t.)H MP 195b65- �° <br /> p� City State Zip < <br /> Property Site Address: ()3$2 FIVaa$ 04%10 1"O , ;� R , w I Cj-1 539 S Z ° g <br /> 0. <br /> r_� n�,Q ., <br /> Contact's Telephone Number: 651 - t�V' ^W d <br /> Contact's Email: la 1 \40-400, Got 1 N b <br /> Legal Description of Property: fit4,:5 ASS 12 3 )L\' 3 T <br /> 2 u. <br /> Section#: 7 fro Town#: IA 0 N Range#:_ 11 W Town of: U t I OtJ <br /> *Attach additional page if needed for lengthy description OR attach <br /> h 1/v <br /> ac�opy of the deed OR attach tax system property page.* crl <br /> Tax ID#(1-5 digit number; found on tax statement): L.:/`-'� ' Dp \n1 0 x <br /> Proposed Use of Structure/ ddit _ <br /> Anticipated Start Date: �}o�n:^^ I a <br /> `S (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: OV.ln► - Sewer Installer: tqA 'k <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z it— CQ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x S v <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> I VI'construction taking place for any dwellings, dwelling additions. manufactured homes,manufactured <br /> home additions,and bunkhouses.** / <br /> O1t1 ' 7' leer USLee 6✓' Auw1avt YTabli7 ? 4e 4. <br /> -i Fee Rec:i <br /> Check#: 44/79 <br /> Date of staff site visit: q /OS— /z� )/7-,— <br /> /itl�r <br /> �� Initials of site visit staff: <br /> ____c___:_j3i <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 06706'°-Z-- m <br /> Uu a t! <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF v i 0 <br /> 4 Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . .g <br /> CCPage l of 5 - %:3 <br /> ffil <br /> Burnett County, WI Land Use Application— Rev 12/2021 •_ a _ '' tt , '' 11 <br /> J <br /> 3 <br />