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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> _ Applicant Complete All Sections Below This Line "6 c N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> - d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �� <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 `1 Bunkhouse $250 ° J <br /> ,: i , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F <br /> 4 <br /> Filling/Grading $150 Boathouse $500 ci <br /> P <br /> Permit Extension(1 Year Extension-Allowed Once) $100 17' <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. <br /> Ilk <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. — oz <br /> F ' <br /> Property Owner's Name: H i cx U. A I b r �h t <br /> th <br /> Property Owner's Mailing Address: 22f-/ &/Yl ', a A C-./1 S7-/ ?bt/ MN ,),>//7 F. . rq <br /> f City State Zip y <br /> Property Site Address: Zq4/ /`osj^jl_ /&A., `"'? <br /> 2. <br /> Contact's Telephone Number: (p5/-30 3- -7 0 0(C d <br /> Contact's Email: rQ 6 bre-U'A± Z2-'t4/ C! L Ma I, Corn o -0 <br /> ao <br /> o <br /> Legal Description of Property: 0/ f 14 GW ( 05 9 0 0 w <br /> Section#: I Town#:)U. , N Range#: f'3 W Town of: (jaCK.5alr1 <br /> *Attach additional page if needed for lengthy description ORattacha copy of the deed OR attach tax system property page.* <br /> l <br /> Tax ID#(1-5 digit number;found on tax statement): L-I 7 c '4 £ 5 <br /> Proposed Use of Structur Addition: (.7- z r"'c- / 6.4 n K 60-143e, d <br /> Anticipated Start Date: /5 "3 <br /> p ' (dome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: 5 Q If- Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CpNDITIONS ONLY <br /> --4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: m <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 bunkho ses.* I' p/j ,{-L �,L( m�� aCts/moi+` atflotlAls5 <br /> . of Viten 4/ <br /> 1I(vv✓ bw1,�l•mwst coy to 41L�-: _ /+�� I,���( ��-[n�.�+� qq y Fee Rec: <br /> 6 r� s 6 loll- vtvf--� erCee 3 Ileo/od"5 fel 54►Y'/r�'�. w Check#:_i_ <br /> L 0, <br /> Date of staff site visit: 3/OAA--"� i/�� Initials of site vi 't .t 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: aL. 44, DATE:e5/5 �2 Q <br /> r <br /> UPON APPROVAL: APPLICAN UST POST COPY OF ,, a C. ITfi <br /> SIGNED PERMIT APPLICATION IN PLAIN acturxi <br /> st m <br /> y <br /> g a N R <br /> n — <br /> Page 1 of 5 D 3 <br /> Burnett County,WI Land Use Application—Rev 12/2021 '7c. <br /> d m <br /> OW <br /> L�JJ <br />