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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line z g 1,e <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> x Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 it"--5 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �` 0.1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> I. <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 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. '" o <br /> 1.� <br /> / f / / <br /> Property Owner's Name: 164/i/ ail ddyt'Ply S 10 <br /> Property Owner's Mailing Address: a9 '/2 LitiL�.ti J. +'ljA - W, fey? ° cip <br /> n <br /> City State Zip < \1 1 <br /> Property Site Address: S9 llI ° c <br /> Contact's Telephone Number: 715 -02 38V Jj5 7 A•4,, (01 (rf6 y7]6 )// d <br /> ro <br /> Contact's Email: ki,vecz..9ti& <br /> ,Sj/�,y,l4,1,h S <br /> G� N b <br /> Legal Description of Property: JG7 ("i'1 t jM o Le,3 ? 6/A I 11 V � =' <br /> Section#: 3 v. Town#: �t'J N Range#: / ' W Town of: Dsr/�Iy,y(� <br /> N <br /> 5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> IJ 1 _ rn <br /> Tax ID#(1-5 digit number;found on tax statement): 1'7 7/3 <br /> Proposed Use of Structure/ dd'tion: iktS4 C7 <br /> Anticipated Start Date: /c/2 9 (Home/Cabin;Commercial Business;��►► Bedroom;Deck;etc.) --I 0 S <br /> 41 �,�J CUh1), 'i .n if Sewer Installer:l� P 6 -2"2 ) v <br /> Building Contractor: v W� L �� 4r2 0 <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 /> home additions,and bunkhouses.** <br /> (3111fe,4 au £t S `- -1 T, - <br /> 0 �Wt.\,�,\n,) Y\O\ e-x-(.e2A 2uirotm > 5141\\ 2-4nCI e NPP-241_1ct Fee Rec: .�-C� <br /> rlV -�o be �e�rrwv Cr �e,�rn��I-ed by gII/2lY_Li Check#:o <br /> Date of staff site visit: G/it/74. Initials of site visit staff: (4,�T rn <br /> APPROVED BY LAND SERVICES OFFICIALO(Olkif.---4//e0DATE: Pu.p RZ"/ I <br /> a. ` Inn] <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 03 = 0 <br /> m 5, Z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ° a <br /> vo a <br /> 1 S N <br /> Page l of 5 g -4` <br /> EN <br /> Burnett County,WI Land Use Application-Rev 05/2022 R. <br /> LL <br /> 3 <br />