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• LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> cn N <br /> Applicant Complete All Sections Below This Line 0 N <br /> Permit Types and Fees:(Please,check appropriate boxes) ,- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F.co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 LI� p <br /> )(Accessory Structure(Garage,Shed,etc05 -159'— Addition/Alteration to Accessory Structure $150 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F. <br /> Filling/Grading $150 Boathouse $500 <br /> Permit Extension(1 Year Extension-Allowed Once) $100 o. <br /> w <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. g �` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: J(�kU i Q i,� �-' b r • <br /> a__• 51 .) 0- <br /> 1` <br /> b <br /> N <br /> boil <br /> Property Owner's Mailing Address + ✓ <br /> 56'-f -f,& cr-' <br /> ' Ci <br /> / Ci e Zipo N011er <br /> Property Site Address: I A 4 41 4 L= i.i i..i I o <br /> D6-nna-- C� - 4(—, ,�5—gaiuy' d p <br /> Contact's Telephone Numb'e"�r:� ``,�,. " k <br /> Contact's Email: 101 Q Jlios•'� m5p �� 0 %I <br /> 10 <br /> Legal Description of Property: �� 1 o� (,I-eAr S k t cre 5o <br /> Section#: '-) Town#: LI D N Range#: I rj vv. Town of: �1LetirA 1b. 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> iris cn <br /> Tax ID#(1-5 digit number; found on tax statement): (pZ� -k <br /> Proposed Use of Structure/Ad ition: <br /> ii6 <br /> C 0 <br /> Anticipated Start Date: 7/z. ( ome/Cabin; mercial Business;Bedroom;Deck;etc.) `� <br /> Building Contractor: i9 IS- Sewer Installer: /.,t A" �► 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICE()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,dwel ' g additions, a factured o manufactured <br /> home additions, and bunkhouses.**** .� �✓ <br /> d VVie�r A,l( ee-b s u,,, lla , .-h Y gl/f? <br /> © . /e i 5 �-f- / irK`n �f c�/ s <br /> ip Dec it/1(3frie_kofc.vecic 4- �o-F- 44 7Sf+ �4 NS ' - 3-q. 642(r j5d-ncc.1�ee po <br /> Date of staff site visit: //S/ ?' Initials of site visit off. a Fee Rec: ..5-- <br /> v Check#:574/17 <br /> / ATE <br /> APPROVED BY LAND SERVICES OFFICIAL: / : /��/2� <br /> w< , <br /> UPON APPROVAL: APPLICANT (UST POST COPY OF a CD <br /> S. o. —r: <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z CO <br /> _ CO <br /> c3 <br /> Page lof5crl o0 N = <br /> Burnett County,WI Land Use Application—Rev 12/2021 v <br /> t:, 9 r...)CDN <br /> 3 <br />