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LAND USE PERMIT APPLICATION - Burnett County, WI . g <br /> 't <br /> Applicant• Complete All Sections Below This Line 0 to <br /> CD <br /> , <br /> Permit Types and Fees:(Please,check appropriate boxes) '_ 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 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 N <br /> 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(l Year Extension-Allowed Once) $100 <br /> i „J <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. og P.. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: (A V i *11 <br /> *Pp • b <br /> � <br /> Property Owner's Mailing Address: 2 CI 1< -c 4-s I , hQ T�I r' n <br /> City State Zip o r <br /> Property Site Address: S<a.m.a._ V't' _.ct.. I L-.:J\ 5 L X a <br /> Contact's Telephone Number: 1 vs Ss "1 -- 0 0.S S d <br /> 11 CD <br /> Contact's Email: V Q t v S 1 J fYtv,-. 1 , c C.3-N-1 b <br /> ao <br /> Legal Description of Property: L,t,T (1 'PI c. c 4 L.,k' 11.w' 4-n..- i S' u'° �`r- °Q <br /> V S '�1 d <br /> Section#: I a- Town#: 3-7 N Range#: ( � W Town of: t � -�2 55. <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 /> En <br /> Tax ID#(1-5 digit number; found on tax statement): I 1 ....Ttp ,-3 -i <br /> ° <br /> Proposed Use of Structure/Addition: �r. ,,`` <br /> Anticipated Start Date: C� I ,":51Q . (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -- `1 Vv <br /> Building Contractor: Sewer Installer: t <br /> W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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.** <br /> elle& 4(t 5 cJ�S . fia✓I oh - <br /> /ak-�or k/1^C•� !� ,� Fee Rec:� ). � <br /> x <br /> y Check#: to 1 y <br /> / m <br /> v <br /> Date of staff site visit:b/3` 2-? Initials of site visit s <br /> 624:4 APPROVED BY LAND SERVICES OFFICIAL: DATE: /E7` �°` <br /> UPON APPROVAL: APPLICANT /UST POST COPY OF r ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo ^� <br /> v4o <br /> Page l of 5 R a <br /> Burnett County, WI Land Use Application—Rev 12/2021 <br /> v =3 <br /> a <br /> b <br />