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cA <br /> LAND USE PERMIT APPLICATION — Burnett County, WI Fr g <br /> Applicant Complete All Sections Below This Line O' g t�, <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> e> W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \O <br /> V. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �� <br /> C� <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 <br /> v <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> c <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. I.-- <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o _ ` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. oz r <br /> Property Owner's Name: �A s .r N 4-�� L►f�NLo <br /> �+ 9 Alp . Z <br /> Property Owner's Mailing Address: /0 3 jo S -cot t-' A �. Si- '? L T 4 Cc, OZ r < <br /> �f A ity, , State Zip <br /> Property Site Address: oS Sr2) 'Ad tSc rJ A4 Sty[ & , <br /> 2_ <br /> Contact's Telephone Number: joss _ 9 O V, - -- <br /> 0 <br /> Contact's Email: J I A .N O / O A o d- ►v,AI I. La •,,, N <br /> Legal Description of Property: el Do.% if) f<- RA,gS W `/ Lod" I I C/t Li 9- 0 7� . <br /> 0 <br /> Section#: at Town#: 39 N Range#: l 6 W Town of: PI-p et.)o rJ H. <br /> '=1 <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> uz <br /> Tax ID#(1-5 digit number;found on tax statement): I .:LG I I n tV x <br /> Proposed Use of Structure/Addition: -AR P R ? I <br /> Anticipated Start Date: (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) H jp (U <br /> Building Contractor:^toS Se+u s i' Sewer Installer: .Wfl i_ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <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 <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> c. <br /> home additions,and bunkhouses.** <br /> ©fee+ atl St-Ihbac. -s ONO4 -b be Used -f-or humour hubi-l-a- <br /> 3020 l- L-LM Cl(A)Jed c*LUSS Is ncN <br /> -ih - - tas.4-eriy ID+ Dwilui by iftAL Sane P" Fee Rec: j�u e <br /> 1OI1Dw -clooCJ 'I&&n reKuikwt:P.n+e) durhlbld mi-hya-hbA , op+;ttn G 7 Check#: IIJI/� <br /> a <br /> Date of staff site visit:5 *OMInitials of site visit staff &2.- en <br /> APPROVED BY LAND SERVICES OFFICIAL. ATE:5123/2ovI r <br /> su <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ,:a al UM <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .0 N <br /> WI �i lr1 <br /> Page 1 of 5 z N (74 <br /> Burnett County,WI Land Use Application — Rev 05/2022 <br /> b <br />