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LAND USE PERMIT APPLICATION—Burnett County, WI t .-c, <br /> b <br /> Applicant Complete All Sections Below This Line Fi' N <br /> Permit Types and Fees:(Please,check appropriate boxes) <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ c <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 g <br /> Filling/Grading $150 Boathouse $500 )J <br /> Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> 4. <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 d fferent application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> J � .1 o t <br /> Property Owner's Name: m 'i cam.\ `r' • S-1 '_ A v- t(-)Yl ,1 <br /> ET n <br /> Property Owner's Mailing Address: al 3 5 �rl/ c..Vvr T-nr. (2,1 ( c:4:0-e-r 612.e, ° E Pt <br /> - <br /> City State Zip < , M <br /> Property Site Address: ,2"43 S`f Anc•('w r r.nn ! ( -ehS x w� S-yr el ) o t <br /> _ <br /> Contact's Telephone Number: -1 i S - cLe - ? C.) a <br /> ra <br /> Contact's Email: �I.ICI .1: W i %+\r�fi.3 E (4eA'S`cls.2._ _Neil— N .ti <br /> 1 <br /> P° °° <br /> Legal Description of Property: C - -S (,Lid Leal" (4 TO G.5 c.... (f 0./(v i 9 "°° <br /> Section#: ®'? Town#:T3 e N Range#: RA 5 W Town of: Lo ' ,1-e-i"t^ ff. <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): '15(.13'7 C <br /> Proposed Use of Structure/Addition: h <br /> dition: L U - ��y(rt 3 a -Ae. <br /> Anticipated Start Date: �r pf j;2, -. (Home/Cabin;Comn4rcial Business;Bedroom;Deck;etc.) V <br /> r <br /> i <br /> Building Contractor: m i V.4..' / v n Sewer Installer: t Y 1 lir <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYz % `` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7Z <br /> Fa <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ft <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouse ** <br /> eeA--a it Seib a c,t1g t, <br /> NtY1 <br /> 0,/e1t1 rwi— +0 ce�e. 3 roo S 5r}/ y ,37.5-.48 <br /> G <br /> Date of staff site visit: la o( Initials of s' e Wisit.taff• ,% Fee Rec: — <br /> 3 `�� , u Check#: [© <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3131 al. x <br /> UPON APPROVAL: APPLICANT ►'BUST POST COPY OF y <br /> 1511 <br /> SIGNED PERMIT APPLICAT ON IN PLAIN SIGHT 0 o, <br /> gag W 0 <br /> Page 1of5 w1 N ([1I <br /> Burnett County,WI Land Use Application-Rev 12/2021 r< m 2,. C=3 <br /> '< N <br /> tV <br /> `d 1 511 <br /> 1 <br />