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LAND USE PERMIT APPLICATION -Burnett County, WI a ro <br /> - Applicant Complete All Sections Below This Line 7' tco CD � <br /> Permit Types and Fees:(Please,check appropriate boxes) °' <br /> d <br /> _ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 °; <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200E <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �J <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° yoRI <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r iU lib <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit a qui red 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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z fih <br /> 0 <br /> f rl <br /> Property Owner's Name: .J Re � c1 rn4.wl(,jn e W1 ,q C(a,k1 a <br /> Property Owner's Mailing Address: Ill/9,5-a Hays. 5 r'of ht s1/,gel /4/V�-S7/� 5* n <br /> //�� / ���nn City State Zip <br /> Property Site Address: 30a /TSpc�n Te yea <br /> �c e� /JGn 5v rq it/L5 �/83U ► < a. • <br /> Contact's Telephone Number: 3e-4 -5-07- /9 - 79/,5--q cJ/kmG ..5-- 9.476y ?2S �i... d .--- <br /> E. <br /> Contact's Email: I-WIcSJ,G L\ 6- G{cG' rGv 3,CL <br /> / p 1 1 `` N aro <br /> Legal Description of Property: L U7 6 O 0 ser„ , li t e.�, r1 A-1.3,t(OA )- Yci a e� c <br /> Section#: / Town#: y0 N Range#: /4 W own of: SG u 1'i' V i ria51.- 3 <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): f (9 4/3 / . o <br /> Proposed Use of Structure/Addition: ' Ar 0 't J;f,;, it. U • Q V ° -6- <br /> Anticipated <br /> Anticipated Start Date: (1'1;8 IA w ttS ' (Home Cabin;Commercial Business; .edroom;Deck;etc.) <br /> Building Contractor: /ia()an (3 1.4•f n Sewer Installer: Z.r— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> Po <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 bunkhous s.** <br /> t rlee& all 5e ' J'-S _ 00 <br /> N �u, A4Diivl Fee Rec: ��676 <br /> Check#: 9dl`i <br /> CI I l�� 2- v <br /> Date of staff site visit: Initials o site visit f r <br /> a <br /> • `3/d2— m ] )1 <br /> APPROVED BY LAND SERVICES OFFICIAL: � DATE:6! � 5c^—�-� <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF a ' 1511 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o `N Eli0 <br /> 0 0 <br /> Page l of 5 `: o <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> m <br /> a <br /> 3 <br />