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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> PermitTypes and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $3001 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.)04 $1W Addition/Alteration to Accessory Structure $150 <br /> C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> n J1 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 /> ommunication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated os accessory structures,such os:pergolas,landscaping,etc. o <br /> Property Owner's Name: I'`ar SN-\.0.A b :7;k-kQ \I <br /> Property Owner's Mailing Address: 0 w i' R, ►` Qa&b usy w $3 <br /> City State Zip \ o y <br /> Property Site Address: G a <br /> Contact's Telephone Number: l LD 1J(D I So <br /> Contact's Email: `( N Q t\ `1 V\1 U,rr` C- O y <br /> � n q a <br /> Legal Description of Property:_ /� �3 Gll�' �l. 3f <br /> Section#: Town#: _N Range#: W Town of: <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: Gal'iJ eri- <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 /> /Uof' �v ,r7e uS�d Tarr �1 u tti+4 h �►410�7�7`1��• � Co NV <br /> y 115b <br /> Date of staff site visit: $ (o ZO?-� Initials of site visit staff: /Gt/T a Fee Rec: <br /> zu Check#: <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o10 <br /> z a� <br /> CA: <br /> Page 1 of 5 <br /> g <br /> Burnett County, WI Land Use Application—Rev 12/2021 < r4%: C <br /> m Fno Ulu <br /> a �� <br />