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LAND USE PERMIT APPLICATION - Burnett County, WI c r <br /> Applicant Complete All Sections Below This Line o c N <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r <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 V\ <br /> a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° kj 5 - <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 X <br /> Filling/Grading $150 Boathouse $500 (4 ; <br /> Permit Extension(1 Year Extension-Allowed Once) $100 z. <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. 2. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. PcI <br /> z <br /> Property Owner's Name: ._.,..L C.O//) g terve t—T— a <br /> 1v <br /> Property Owner's Mailing Address: 2. 7 5 (,,,,,,,fry 4— <br /> y'*Jo,-e1- £ fi#6-•=e E N <br /> �j1{. City State Zip o <br /> Property Site Address: . 77 ` F r a <br /> Contact's Telephone Number: _.e4 <br /> F4 <br /> CI <br /> Contact's Email: //.iC- /'7 i:::,of rk f+ 1--a 6 414`(-L‘.."'''- oN t <br /> o. <br /> Legal Description of Property: 1-197 2 C5/17 V . P ( 1 Li (3---3 Q 17to) d _ <br /> Section#: 1 t Town#: 3 N Range#: I W Town of: R..A..5 5. <br /> tO <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): 15.844) �' <br /> R <br /> Proposed Use of Structure/Addition: i✓v"G 1 I+ <br /> Anticipated Start Date: me/Cabin;Commercial Business;Bedroom;Deck;etc.) `-3 1 <br /> (31 <br /> Building Contractor: Sewer Installer: <br /> A RP <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,manufactured homes,manufactured <br /> home additions, and bunkhous ** <br /> 0 (ne6-, au 4 S ,2 b(c s pe.,-- <br /> �ltI - � .0 �JV ...3 <br /> x <br /> 1� CA <br /> 7 <br /> MATE: <br /> o Fee Rec: <br /> Date of staff site visit: 31 15/?"?" Initials of ite vis5(� <br /> / Check#: <br /> APPROVED BY LAND SERVICES OFFICIAL: < <br /> UPON APPROVAL: APPLICANT,- " <br /> NTUST POST COPY OF r C3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT - a <br /> 23 <br /> Pagelof5 ' yW w <br /> Burnett County, WI Land Use Application—Rev 12/2021 . F 2 N o <br /> 3`. <br /> 3 rN Q <br /> ^ <br /> a WO <br /> 13 6 <br />