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a <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a c <br /> -o <br /> Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 - o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 u, X. <br /> A, <br /> Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> a. <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. E' <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o lbIz. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: Aark tk el, <br /> ^ b.eri ? 1. <br /> Property Owner's Mailing Address: /0Z`1 ID r ia4L R2 `a , A'Icr[ticwr.) 4,141 5-S/1`1 (tJ <br /> / City State Zip < 7- <br /> Property Site Address: ZYCpat 1 ki/A2.o.(–sic; /�a, We b5/ r-- uT cV893 vow a <br /> Contact's Telephone Number: / _GC/ –21 y-46-4)0 d <br /> Contact's Email: ------ N <br /> cro <br /> Legal Description of Property: to+ / CS.N1 V 3 P 60 t X e /co `O 6e 4., . V <br /> Section#: 0 Co Town#: 38 N Range#: /S– W Town of: A f-o/le7&1c - 4 <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): "/8G <br /> o -] <br /> Proposed Use of Structure/Addition: /-lo on L I 1--- o <br /> Anticipated Start Date: 55"-/5.--ZZ (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) -' <br /> --L, <br /> Building Contractor: /3 z 4^Z ei -.• Sewer Installer: /4-bel;',s � .Z T1� <br /> a..2 6,e4 <br /> t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY (N 1� <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 /> 1.'V Y construction taking place for any dwellings, welling additions,manufactures,pnaanu factored, <br /> home additions,and bunkhouses.* 5k .0 (k <br /> 0 Cep- all 5e ���»J///��' b 8 1?2 r <br /> e p,,,,e ll, rlo-1- ito e 3 bye ,-r S per SA-w-2a-3/L! = Fee Rec:3C <br /> 4 St%1K 7, be ✓eFhOec b e/1 i?', o✓ +'eol ;4 e 5441'1el Check#: 3Lizi <br /> Date of staff site visit:L'/i CI('"2" Initials of site visit aff:r( rna <br /> C. <br /> APPROVED BY LAND SERVICES OFFICIAL: CJ�� +�t // /DATE: yl?"°/a� X <br /> UPON APPROVAL: APPLICANT> UST POST COPY OF 3ffil <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Ji n <br /> Page l of 5 ii <br /> o <br /> Burnett County,WI Land Use Application—Rev 12/2021 <br /> m litil <br />