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f <br /> t <br /> f l <br /> LAND USE PERMIT APPLICATION — Burnett County, WIc. n b <br /> Applicant Complete All Sections Below This Linc c to <br /> Permit Types and Fees:(Please,check appropriate boxes) _ n '— <br /> y <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commerci al/Industrial Structure $200 --• ,11.- <br /> .g <br /> vO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 7 1% <br /> Filling/Grading $150 Boathouse $500 <br /> XSolar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 =cn al <br /> v <br /> *NOTE:After-the-fact permits(permit aqui 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. t- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> Property Owner's Name: OCA,cl i CX /0 dS01 ° g <br /> G � <br /> Property Owner's Mailing Address: 0 9 /9 m; eJI Rd ��,1�b l.c.)I _5-1-1, 3o n <br /> City State Zip <br /> Property Site Address: 5-)Ct,/'Y\S_ <br /> Contact's Telephone Number: 0—6230—�7�R. - d <br /> Contact's Email: <br /> CX <br /> Legal Description of Property: LA 3 QSvrlt )9)8' 1/ /D P .231 (t•, C:G/ LD-7 1 .Sec I I w CiDV LOT S S 010 ao <br /> C). <br /> Section#: / ) Town#: yo N Range#: la J' ) W Town of: JQC,k_SOY <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): .5aa(� 1 �H <br /> Proposed Use of Structure/Addition: SDI C,,r . fo <br /> P <br /> t7 r <br /> Anticipated Start Date: 7i 1 / ;�- (home/Cabin: nnmerciol Business:Bedroom,Deck erc.t <br /> Building Contractor: eY1- EALr d SoIui-k-,'1 Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 A <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 Ir J <br /> ANY construction taking,place far ant,dwellings, dwelling additions, mannfacturcd homes,manufactured <br /> home additions,and bunkhouses <br /> 0t ref• a 11 SL-ja, <br /> N 4. (��il.a f•Q !(S /!e d� �(° f�- i;d be ;. 1► Fec Rec:�� `r <br /> h.'e L'se y ee6/5 4-D bt• 51-1,)4I;ted 4 oM e✓osio✓1 .1Yo R4 i s Check#:&Ow' <br /> Date of staff site visit: 7171?-o) Initials of ite visit st.ff l l c7 <br /> 475% , q <br /> • ° ==APPROVED BY LAND SERVICES OFFICIAL: , / DATE: 7/8/ ? ti) � <br /> G Y�Y <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF <br /> A z3 r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -1 «' fit <br /> z 0 <br /> ✓ �� <br /> Pagelof5 n 3 <br /> iiiiil <br /> Burnett County, WI Land Use Application—Rev 05/2022 F_ g <br /> m J0 <br />