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LAND USE PERMIT APPLICATION — Burnett County, WI a c <br /> c "til <br /> Applicant Complete All Sections Below This Line B' N <br /> Permit Types and Fees:(Please,check appropriate boxes) y o --- <br /> Dwelling/Principal <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $2000 <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 , ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350ob <br /> Filling/Grading $150 Boathouse $500 g) <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. a . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 b' <br /> Property Owner's Name: cna\. . (1 C1 'f 3 \L -, ii <br /> Property Owner's Mailing Address:Sly cAc _a` <br /> of\c 3 \a,/tet`r`\aL ,, }N,,,,, 1/ ,..)-17 1`t '' ' <br /> t, City. Stat Z• , g C - <br /> Property Site Address: a5,`--� - ,�GQ�rz l\ �jf e'r\�j rc\ b� gi " <br /> JJ cl.e C <br /> Contact's Telephone Number: (_,\� 2 1-0 to o 7 <br /> Contact's Email: Con,.bod\c.Y1 cr-Atib1, C c t-\ <br /> 0 tic <br /> Legal Description of Property: `/y 1\14 icy <br /> Section#: 2.1 Town#:3(1N N Range#: \CA W Town of: _c> c a . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 7:1) -i --3 <br /> Tax ID#(1-5 digit number; found on tax statement): ILk X <br /> Proposed Use of Structure/Addition: CyxCa0) b 4 itec,(3 <br /> J -I <br /> Anticipated Start Date: (Home/Capin;Commercial Business:Bedroom;Deck;etc) <br /> Building Contractor: \eS('C1 c\a V,i%Z.c.' Sewer lnstall :Ca;' / #O C SCD c\ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIO S t ONLY r <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,manufactured homes,manufactured <br /> home additions,and bunkhouses.** 1 11 <br /> 1 pelee4- 411 5eA� . �,�,� <br /> CO rte- h.iia 4R,b, <br /> nq �p. vyb/tt 44411 30 ( ;,4 a - -f rail C' CvAtPI r <br /> PPerch 15 PI - <br /> 4 1 l `r:-.1 Fee Rec: <br /> Date of staff site visit: �'�'d" Initials of s'te visit st.ff:� <br /> . /_ o Check#: <br /> APPROVED BY LAND SERVICES OFFICIAL: A_�.1 / /L" DATE:Lib?/a?( 212 ._ O <br /> UPON APPROVAL: APPLICANT "r/ ST POST COPY OF iPO <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTi. g) 33 © <br /> = Gui <br /> Pagelof5 y ) o'o <br /> � O <br /> Burnett County, WI Land Use Application —Rev 12/2021 a.• <br /> _` Q <br /> litil <br /> :� <br /> L <br />