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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line tk <br /> Permit Types and Fees:(Please,check appropriate boxes) da. <br /> XDwelling/Principal Structure r$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 N g <br /> LI <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o U <br /> Driveways/&Campground Structures $125 `WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r <br /> v, <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <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' 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' z <br /> Property Owner's Name: Mark ♦ Lou 41/1 L I hrcA ;Gi 1 v (/� <br /> Property Owner's Mailing Address: ,212y /Illef%oK Cr* fi'tij H i/ a 34/406 ° <br /> City State Zip C <br /> Property Site Address: 2(,3 4'4 Ile,/jc,f.4 /d• the r it r t wz S�/6'9J ° a <br /> p 7/S• 733 — o/S/i/ <br /> Contact's Telephone Number: O d lk <br /> Contact's Email: fiI VA//NYc%.;el Gat ho'0.4,f . CO M. N <br /> ON -1 <br /> o <br /> Legal Description of Property: 0 7 - D /G ' 2 ^ 39 -/ 7 -12 • 1 0 t/-OOO - O/.2.t oO 0 <br /> d NI <br /> Section#: I Z. Town#: 3 Q N Range#: 1 7 W Town of: 1_/ rt C •lam. 5. NI <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t/J <br /> Tax ID#(1-5 digit number;found on tax statement): /o S yG <br /> k)- <br /> Proposed Use of Structure/Addition: ft or.,,,,.L, (rt. r7 <br /> Anticipated Start Date: "A V "' ZQ ,41_ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H <br /> 14 <br /> // <br /> Building Contractor:A.4 els'eAe./0, Sewer Installer: .ZA # 6 SO q 2.Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> po <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 ._I <br /> home additions,and bunkhouses.** <br /> 0 n1 e0- au t-I1xcc kS <br /> 2 ���t �� no} -10 ,ezto,d I \d ooni Fu S -23Jc1 _, Fee Rec: �Q <br /> Dy"�"j"' Check#: ((AN <br /> _N <br /> E <br /> Date of staff site visit: '/I 21-1 Initials of site visit staff: (IL,* v-,T r <br /> a <br /> G z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓/f 7/ aq �--�� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y <br /> > . 3 ---‹ <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Page 1 of 5 m =.� y <br /> Burnett County, WI Land Use Application—Rev 05/2022 < <br /> m a <br /> 3 <br /> �o <br />