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LAND USE PERMIT APPLICATION - Burnett County, WI a `° r <br /> < <br /> • Applicant Complete All Sections Below This Line 0 c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structu a $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage, 4+50 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 °. c4 1i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N lb <br /> li <br /> Filling/Grading $150 Boathouse $500 c <br /> Permit Extension(1 Year Extension-Allowed Once) $100 ' <br /> w <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. b . Ilk <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> �n r~ <br /> Property Owner's Name:��( $ ( 2J-LQ -c, <br /> 0 <br /> Property Owner's Mailing Address: E <br /> City State Zip Ow' oProperty Site Address: �j7 /74:ri-/-- P D. ;=,• - co <br /> 0. <br /> Contact's Telephone Number: 6.. l�— 3/& .. 70 Jo d <br /> Contact's Email: /� N o' <br /> 0. <br /> Legal Description of Property: p�E-plT >�S770' <br /> r y D V V t DT 3 Z. o <br /> P. <br /> Section#: 1i) Town#:_ `e',0 N Range#: /. W Town of: 4 C j<5 e 't.i. a"'. <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): 70/92 ° <br /> Proposed Use of Structure/Addition: (74'k1246 C• 40 0 d_ <br /> Anticipated Start Date: ,.'/-- -01/3"" (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) A <br /> Building Contractor: _..C .-//C Sewer Installer: <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,manufacturedmes,manufactured <br /> ho ,dditions and bunkhouse .** GWit 5ti ,icCiv+o ✓Se per%f •c- <br /> l nill a it a 1 5 (� lYy dv« too Ef 61!/i3 <br /> �' P,r�,'(C'7 5;✓ a Mme- b�dmoe IV corn b;� SE'S b? 1 ol1/a) a x <br /> ov'Mk f s n' ' v, <br /> 1 m <br /> .S o "� <br /> Date of staff site visit: 3/� --11 ?a Initials of ite visit staff: 1' a Fee Rec: �� <br /> ,�j 2 / FCheck#. / c S <br /> APPROVED BY LAND SERVICES OFFICIAL: / DATE: c7/(6/ 01 -_5) <br /> UPON APPROVAL: APPLICAIUST POST COPY OF 0 <br /> N' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT9 <br /> Page 1of5 0 Q .7.2 <br /> Burnett County,WI Land Use Application-Rev 12/2021 x <br />