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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> • Applicant Complete All Sections Below This Line =N <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 K <br /> CD ti <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 G1 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r9 R <br /> 9 <br /> - I Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °_ <br /> /1: Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 C `'-, <br /> VVV Filling/Grading $150 Boathouse $500 w <br /> r. <br /> Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 4 <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. 07. ik <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' . <br /> Property Owner's Name: 6-4-72.(( _ _Li-/efcb-r__,<.. Fo <br /> c26; 5-0' /._ R16 /_•1,<i , ) • <br /> Property Owner's Mailing Address: <br /> 5(9--ye <br /> CityState � <br /> Zip <br /> Property Site Address: 5F/ -'r e -3;.. ' <br /> a <br /> Contact's Telephone Number: 6/c -72 S-3 5 3 <br /> /J .. <br /> Contact's Email: (>/�S rK 1/E R/4/6--t'V4-ii-90. Go/?7 N <br /> Legal Description of Property: F.r!• GOV. Lao <br /> 'J d <br /> )67Section#: ' Town#: 31 N Range#: y W Town of: RV sK 3. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* D cn <br /> Ve'Tax ID#(1-5 digit number; found on tax statement): 157 60 o <br /> Proposed Use of Structure/Addition: t7 <br /> Deck <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H ..t--n� <br /> Building Contractor: Sewer Installer: <br /> V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x <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 bunkhouseA** <br /> 1 rflee-c- cc lI 5e-Ho 4tis <br /> • <br /> l jA 4 Gr`ct di t5 ne�: Ge d 5erhC- et .j Fee Rb 1 <br /> 7 Check#: C1,4 <br /> /^ mi <br /> v <br /> Date of staff site visit:5/KJ ii?- Initials of site visit sta f: a <br /> j. , <br /> APPROVED BY LAND SERVICES OFFICIAL: i // DATE: -✓/,�1g c2 <br /> UPON APPROVAL: APPLICANT ST POST COPY OF > 'woo <br /> ififil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo <br /> Page l of 5 `` N <br /> tif <br /> Burnett County, WI Land Use Application—Rev 12/2021 < arn <br /> cn ' ' <br /> a <br /> rt <br /> b <br />