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LAND USE PERMIT APPLICATION—Burnett County, WI `° r <br /> Applicant Complete All Sections Below This Line 0 � N <br /> Permit Types and Fees:(Please,check appropriate boxes) °, <br /> d <br /> Dwelling/Principal Structure $300 X"Addition/Alteration to Dwelling/Principal Structure $200 °- <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .-.1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �tN o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 -:g' -.— <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 or <br /> IL) i <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g. <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. A)" <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 (b <br /> / o <br /> �� . Lx ` d L 6c o <br /> Property Owner's Name �° w\ k5 a �l5'— (LAS FE <br /> ,�,p <br /> 553.75AAAI w <br /> Property Owner's Mailing Address: �3 3 3 a ,r- -\,_��4 t ANs,.,k vt�' •JcN AIV <br /> �/ City Sta e Zip r---Property Site Address: (3' / Fs' }�.._,,'�-���•r�u 5e,,,'v..t, .� 5 gd` c, . r,.r 1\ O <br /> Contact's Telephone Number: 9 S -I 07— I B c-O (/(/�01.,. - .t) b (� <br /> Contact's Email: -0—C A. L L(ks- € AOL Co AA N qfQ <br /> ro <br /> � 0 <br /> Legal Description of Property: Lc, ..t <br /> . , �'_•5/ V a 6 tpQs (6 O y LO Tii) I <br /> v <br /> I Section#: 3 Town#: 1/0 N Range#: 111 W Town of: C c..' '-k- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> PE) cn <br /> Tax ID#(1-5 digit number;found on tax statement): 3 Y S 7 573 c <br /> Proposed Use of Structure/Ad ttio : A A k\--\-‘. --, 'Co iNsi•N..c:..f-.. S-k---,t..1.G�..or' ci <br /> Anticipated Start Date: 1 / ( 20-1� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 W <br /> Building Contractor: r--'cz 4: eo,A.s-ti%A. ,a-... Sewer Installer: 'k,,\,____.- <br /> raw (. �` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v 1 <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 x <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> (►ine -, GII se- (1., <br /> nt <br /> e,O,Nell ✓lob- ,-I-0 ekceed �/oans per 5444-1,7-7? y Fee Rec: OO <br /> I'D(��►M-� ti n A r�� y Check#: 3 O <br /> �� J L d y <br /> Date of staff site visit: �/) 7/2?"a Initials of site visit.t• v, <br /> / / C3 q ›- <br /> r <br /> j" . <br /> APPROVED BY LAND SERVICES OFFICIAL: i V / DATE: !�/?? .. <br /> UPON APPROVAL: APPLICANT , UST POST COPY OF 401( E: �rt1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> iii <br /> N n -P t=7 <br /> Page 1 of 5o Cg <br /> Burnett County, WI Land Use Application—Rev 05/2022 l N <br /> . Q <br />