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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> • . b <br /> Applicant Complete All Sections Below This Line c t� <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 E <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 \ ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 t,_So <br /> Filling/Grading $150 Boathouse $500 xJ si <br /> K <br /> Solar Panels(Stand alone or roof mounted) $150 .><Permit Extension(1 Year Extension-Allowed Once) $100 = . <br /> r <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. i !`, <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 <br /> 0 <br /> Property Owner's Name: C n (LS 4-6 9 flet' 11 (ei"_.vl ii <br /> N <br /> 0 <br /> `Property Owner'sMailing Address: CaCl 4011 f r, )JiL;No Lares, MSO 55038 <br /> / City State Zip <br /> Property Site Address: (p ?, �QV�.5OVl S e1 gd'y &c,tviisk r , Gli. sVg'G ° <br /> h a <br /> Contact's Telephone Number: 1 (c- 413) I ) I - Al t 4-G K./et V1 t7 <br /> CD <br /> Contact's Email: S r/a 61 0 c-ett,1 4-S 1u(-�-*IGD m - V)e o <br /> Legal Description of Property: .Se e a (t¢G N�.z,&+ in ox- c( c 0 eL( pe v•WI,4- a f f,leeti.1 a ^` <br /> Section#: 3 3 Town#: 3 g N Range#: / % W Town of: i Jn wd lq c U er- 7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 00 <br /> Tax ID#(1-5 digit number; found on tax statement): 3 7 67 4W f <br /> Proposed Use of Structure/Addition:q + Net,) h c v"-e AAA el 5Tc2;r •- l��".e ' ../.,.4. . t7 <br /> Anticipated Start Date: yll ; el -J..0 N.Q , ,D ( (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: 5 C j-F Sewer Installer: �x Je ?a -�s h 0, /bh W p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c 'J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z Q <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.** 09 <br /> d i's i a one. year e.x nM,M 4 GUP- 2I-39y, pe vim,f-- <br /> elc ptbe $ CD/Z3/202,3* / / Fee Rec: �LX <br /> a �1eler dtt4$ �6- /UVJ° / $e.G 0 a" 'e.4 ` Check#:v71/3J <br /> v <br /> Date of staff site visit: Initial i f sit it staff: <br /> 1 .401111110 r <br /> zk <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 Z2-- <br /> Nil <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ?a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT d - INil <br /> ; co 7 <br /> CIC <br /> Pagelof5 � � r <br /> Burnett County, WI Land Use Application—Rev 05/2022 < ; 151i <br /> m d.. <br /> v 143 <br /> a <br /> 3 <br />