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3ba 16'As :-- If 9OC. 0� <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) / d <br /> Dwelling/Principal Structure $300 I Addition/Alteration to Dwelling/Principal Structure 34G 2 C3 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ►% g <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 0 ti <br /> Filling/Grading $150 Boathouse $500 <br /> Q, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 g <br /> *NOTE:After-the-fact er i ermit aquired after construction has begun)may cost up to three times the normal fe� ' <br /> *Communication Towers&Signs require a different app ication yorm;see corresponding application,and fees. S' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o rl <br /> (� o O <br /> Property Owner's Name: SU3$I I I Q J 5Ort E(J( . �a <br /> (j E. C7 <br /> Property Owner's Mailing Address: )V-19 (O(1 ! {( s �?j��r 5/(fO/ 7 <br /> l�( "City State Zip, o t <br /> Property Site Address: X1'1' 1 C®c�,, y Ra E Sp older um 5-Yet)/ 4 g <br /> Contact's Telephone Number: • T d <br /> Contact's Email: __N 1)x 5(pO 09 flag I I L e n'1 o cm <br /> Legal Description of Property: 1/114 i s7 3/ 7`-.5-914 la �!,(/1)f SN/!(e. LSD M b <br /> Section#: 2 Town#: (/N Range#: / W Town of: 5c( \1 a. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* .» W <br /> rip 6' <br /> j 36118 36//9 3a mo 36/z( <br /> Tax ID#(1-5 digit number; found on tax statement): ` � � � � (v � � <br /> Proposed Use of Structure/Addition: 4 ,s t Al itii lit u .5 bOa w 0 <br /> W <br /> Anticipated Start Date: Co'IN ' t , (Home/Cabin;Commercial Business;Bedroom;Deck;etc) .seg pis N l H 1 • <br /> - (-.- <br /> Building Contractor: 003 N o Q k Sewer Installer: V 10 K I i'4S O` e i i...0 <br /> i, q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY I '' I;I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 1 , \ I <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.** // / „ r L / " k NA <br /> ,s pe -\i'7' is -6or' ' fvr.� cad- fivitS On/' ex-1$74,( (iY') N <br /> 61,k1 % S, upiI' 3 g 5'9 NI �o. See �N4o /af- co a,4i ' <br /> C S w1 Viols 0-6 •ZZ./Ii': G�r+r-� 40 MOPE- ex ti S4/4 9/4 t)ed _ <br /> � y <br /> Date of staff site visit: T $ �Z Z Initials of site visit staff: /j��,L"� 1- Fee Rec: SCC, <br /> p Check#: al/6 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 00492'2 - <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Gill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> z fid <br /> 0 Co <br /> Page l of 03 0 <br /> Burnett County,WI Land Use Application—Rev 12/2021 N <br /> K <br />