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LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d "1 <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 ? <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 _WI State Statute 59.692(1v)Structures $350 9, <br /> Filling/Grading $150 Boathouse $500 <br /> 4 <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. g' + <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 1 \. <br /> Property Owner's Name: —7-110(14 rtS 'i— K.tt.--T H [--t v Li p -7& N o, <br /> i w, n II <br /> Property Owner's Mailing Address:€-7 7 O I /V PO 4 N T L 1c j2-j) w e d 5tc--� cA S`/b 2 3 <br /> City State Zip < h <br /> Property Site Address: 341'►1 e• c g (,1' <br /> a <br /> Contact's Telephone Number: (c° I ' 9 ( -C-3 SS. d <br /> Po <br /> Contact's Email: Ft--tot-.-.Pc n o-t-&AJ 0 Cc"►.--c A5`r , ...Qt.,-t' <br /> E. <br /> b° <br /> Legal Description of Property: <br /> d <br /> Section#: a <br /> ct Town#: LA 0 N Range#: fi> W Town of: ..!y.}c t s0 —_. 3. <br /> o <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 s Cement): 5 1 Ai I i ; <br /> Proposed Use of Structure/Addition: 511e..4 C_ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `- R <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 7 <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.** p,� D p CeOgig pk <br /> �/hee-4- a II 5e-4- s "fP e le.v�I' poy oa <br /> rklvtl—c6( hi.t44144 ha 6) .4), -3 Fee Re 150 <br /> N Check#: C0.5h <br /> rnv <br /> Date of staff site visit: Lib <br /> 1 1?. � Initials f site v' it of / r <br /> Z <br /> V <br /> 1�/ cn <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: `/ '9 cn Q RI <br /> m <br /> UPON APPROVAL: APPLICAN> , MUST POST COPY OF 6 ii <br /> a, m a NI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT • o 0 a <br /> • aQ. N <br /> N <br /> Page 1 of 5 . 3 R1 <br /> Burnett County,WI Land Use Application—Rev 12/2021 LL-----)) <br /> a <br /> i <br />