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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> b <br /> cn Applicant Complete All Sections Below This Line o t� <br /> 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ',,:1) i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 IVB <br /> n <br /> ��eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 E N <br /> Filling/Grading $150 Boathouse $500 c <br /> Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. a r <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. i; g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: ./E 1 ///ne?-r ii <br /> Property Owner's Mailing Address: A/6-3,,,/$ Q �� ,6�,.4� j /,2 ,S-0/4- E <br /> City / State Zip o ,7 <br /> Property Site Address: Q/9s 7 sjpiri/ . '� �L/ . 6-e0Ort:�/i .5V 37 <br /> fcq <br /> Contact's Telephone Number: 7/S'22Z- S 7 d <br /> Contact's Email: /MudjeJJ_h4-o/ i4*, j-j/N/ LB,y, z <br /> Legal Description of Property: Q L- L.l1 / °Q <br /> d <br /> Section#: /.2-- Town#: 3-7 N Range#: / W Town of: 7/1 ,p,,_ 44'.E g. <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 /> Tax ID#(1-5 digit number; found on tax statement): r93` 6,S ; `4F <br /> Proposed Use of Structure/Addition: peG/C i /2_172/ (..!) 0 6 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) `j '\ <br /> Building Contractor:, .,t. fr.43 e 1 Sewer Installer: , L <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6� <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.** kc.(A <br /> I' <br /> DI;S ;S j tf C d4 t 5 1 bekt6J <br /> 1�'�`e <br /> /5 c `5C+194.c* 47) 4e 0(4 4+ h k lnvgrkr trait z Fee Rec: N <br /> Check#: b)(239 <br /> f J 2 l v <br /> Date of staff site visit:5/3/'?? Initials of site visit staff: +11-- <br /> 7- <br /> }' v m <br /> 67C(2'.A. ' ll J� <br /> APPROVED BY LAND SERVICES OFFICIAL: A, __�/ �-41"i" DATE: "`b <br /> UPON APPROVAL: APPLICAN UST POST COPY OF W -0 0 <br /> 3 via <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m (a. IN)g <br /> Page 1 of 5 a <br /> Burnett County, WI Land Use Application–Rev 12/2021 _ IM <br /> L <br />