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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' c N <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 It 'cI\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 fes} o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o a <br /> Filling/Grading $150 Boathouse $500 r r <br /> Permit Extension(1 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 /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. I <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 5. <br /> Property Owner's Name: A a la. t' N �P TO ill o <br /> . <br /> ts <br /> Property Owner's Mailing Address: �� s1 6 girl 0 Yh pSo u n�. n" <br /> ° <br /> City State Zip <br /> ET <br /> Property Site Address: ��rrne, •o <br /> coa <br /> Contact's Telephone Number: 17 I rj 39-v— 1R-/ ( 71 v <br /> CD <br /> Contact's Email: OWN R 'O lV a- f- ' . GT( &J L-,C '31r/ N b .. <br /> r °c IQ <br /> Legal Description of Property: L04 13 (Stvi 301 va J)2 <br /> Section#: -27(4" Town#: L1'0 N Range#: IS W Town of: ' ( CCS,rte g. <br /> *Attach additional page if needed for 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): 66'7 / ) o p <br /> Proposed Use of Structure/Addition: `P.e-'fvuc.i 9 d <br /> Anticipated Start Date: 3411 � <br /> ? �_ (Home/Cabin;Commercial Bedroom;Deck;etc.) `- <br /> Building Contractor: Sewer Installer: _ O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Q <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 <br /> home a itions, and bunkhouses.'** <br /> 1 illee2-- 6111 Se1" �-5 t� ) <br /> i J 4--fir 1A.tmah kb -W <br /> 2 <br /> 7 <br /> VI <br /> Date of staff site visit: .2--1/5/? Initials of si a visit .taff•� a Fee Rec:/5Z. <br /> rI - / r� v Check#: r <br /> APPROVED BY LAND SERVICES OFFICIAL '�M� / ' -/ % DATE: 4-1/5�2; ,; <br /> Q <br /> UPON APPROVAL: APPLICANT MIJST POST COPY OF t GI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w 0 <br /> f� <br /> Page 1 of 5 0 <br /> Burnett County,WI Land Use Application—Rev 12/2021 ' ' 0 14 <br /> OW <br />