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<br /> LAND USE PERMIT APPLICATION — Burnett County, WI c r
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<br /> cn Applicant Complete All Sections Below This Line c t�
<br /> Permit Types and Fees:(Please,check appropriate boxes) ,
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 9
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O
<br /> \.:: Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
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<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250
<br /> X. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r
<br /> Filling/Grading $150 Boathouse $50A v)
<br /> X 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. CD r
<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. .---., o
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<br /> Property Owner's Name: 2-- 1%t a c( , w �//` e/'
<br /> pp 5-S-81.05.
<br /> Property Owner's Mailing Address: 7 2 Y A/44 g+.c GCr k L,1 /x'Z AC cq ,
<br /> City State Zip o
<br /> Property Site Address: (.9 g L(CJ 7Jw'a F c..k , ,)---,/2r sc.) --p,..._, y v(,,-, _a \N
<br /> Contact's Telephone Number: 2 1 e --3c1 ( z 6 3 c/ I d
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<br /> Contact's Email: Z IA- /3 / p2 c) 7 CY J c1 /-----,.., l ,. (J-2,-A- i Z
<br /> Legal Description of Property: P( L i -... C-' L 5 ,,
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<br /> Section#: i 3 Town#: c f/ N Range#: / 6 W Town of: S w`. S 5 E.
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<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number;foundon nt): 2 t ? S 7 1 ;
<br /> Proposed Use of Structure/Additio •• /-1(..),-,4c • - T®L�i. _
<br /> Anticipated Start Date: /S e,:—.... ..."----7- (Home/Cabin;•Commercial Business;Bedroom;Deck;etc.) V(`
<br /> Building Contractor: LL-1 . 5 c,�. s t r\ 4 4..,,N. S Sewer Installer: (4° c ,{S cam,.,,.0 4— f uza
<br /> l 676.
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z
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<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
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<br /> Iii i: 2kICA fi;04 ;5 --V( -� ci,bikq C_
<br /> 5� Iles kL Use- permr'r b 8!l I o- `'
<br /> r_ x Fee Rec:
<br /> =�oIID✓ 4 U CD/t�f�'1 D►~S /h �,V /�)) EA
<br /> EA Check#: fir-°`5
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<br /> Date of staff site visit: 1 I26l aa-- Initials of.ite vis' staff. 1-11-'" ri , "''
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<br /> APPROVED BY LAND SERVICES OFFICIAL: I r
<br /> /_ I/, DATE:/l P i r
<br /> i �7/� < g Gini
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF g 33 0?
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<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT cgos>
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<br /> Page 1 of 5 7'3
<br /> Burnett County,WI Land Use Application—Rev 12/2021 i 4' +�
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