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• <br /> i ; <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Pi it 4t <br /> Applicant Complete All Sections Below This Line 0' c <br /> Permit Types and Fees:(Please,check appropriate boxes) d ,.� <br /> Dwelling/Principal Structure $300 ' V Addition/Alteration to Dwelling/Principal Structure $200 a w <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <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 0 <br /> Filling/Grading $150 Boathouse $500 <br /> el ir. <br /> Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> i <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. :11- <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 6' I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. _ <br /> \2 Property Owner's Name: .�� ei Cb b 1 <br /> Property Owner's Mailing Address: )C. • A\ '.- o.� 1 4 w <br /> City State Zip o <br /> Property Site Address: 0 I\S 0 A.\* ��\ \ Z N a <br /> c <br /> 2 <br /> Contact's Telephone Number: 3 (9-5Q, S a 5© , d <br /> CD <br /> ;� it coo ( Ci'14i I V <br /> Contact's Email: ���� � <br /> • <br /> Legal Description of Property: °O N <br /> d N <br /> Section#: 8 Town#: L'I 0 N Range#: /fr W Town of: 04)G L 4jt/cl 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 1Tax ID#(1-5 digit number;found on tax statement): /'1301 f� VJ O f <br /> Proposed Use of Structure/Addition: /�oWt£/6.4 hi rl) / 6,i_+L/1 2 0C> r� a <br /> Anticipated Start Date: l�$r{r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` - <br /> d1 �1.43-zee✓ (d, <br /> Building Contractor: 6� � l't5"--/244c ��dp. Aewer Installer: /4/6/3 k'•41-5 d <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 6- <br /> home additions,and bunkhouse ** <br /> 0 ill�e2-I q,Gl jcu,,S V 2 no --I- <br /> �i1q no exceed 2. bed.r000'1 pe-r 941 J-22-i3 <br /> C)CoaciTA ?o1-lo Card GIN S+'Uc. Ares Ovtr 100 Scc44- need CA Land Use Fermi-}- _i Fee Rec:c C <br /> 17-1 111 IamN econ4to. urti.F&rm t i v Coc.Pe ins, - -fir cfti( ae„,,scyy Check#: 91//2 <br /> Date of staff site visit: GJ 00 j7/1-k Initials of site visit staff: (j1-4' VT ftrivR3 m <br /> a <br /> Z ":o <br /> APPROVED BY LAND SERVICES OFFICI DATE:(92/ l 2Ozy <br /> ` w <br /> a. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g E g 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo <br /> i5 PS <br /> Page 1of5 <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> mo <br /> �J <br /> a <br /> 3 <br />