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<br /> LAND USE PERMIT APPLICATION—Burnett County, WI 0
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<br /> Applicant Complete All Sections Below This Line t-.)
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<br /> Permit Types and Fees:(Please,check appropriate boxes)
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 5 `•0
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/industrial Structure $200
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<br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
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<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk I Bunkhouse $250
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 )•),,
<br /> Filling/Grading $150 Boathouse $500
<br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100Ei ,,,
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<br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. -4
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<br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r p
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<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. •
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<br /> Property Owner's Name: 0.4,4)t 1 , ,.34rit, 30
<br /> Property Owner's Mailing Address: 0 It ()Or,9_LAP-0, 0 C i-- ApfklAle..4 P\0 CS r).-Li '''T (-)
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<br /> , City ,..1 State Zip
<br /> Property Site Address: (032,8 fli ik C, 4.K'it-^44. eek. .;... F,.
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<br /> Contact's Telephone Number: 012- -(0C(1 "1 4:41 i3 46
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<br /> Contact's Email: cj s 04°04—049 7\461,olw, 1
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<br /> Legal Description of Property: (Pc.,1 1..)01 S .
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<br /> Section#: 624 Town#: ...3q N Range#: 1(1 W Town of: ) i 4..110 rl
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<br /> *Attach additional page tf needed for lengthy description OR attach a copy of the deed OR attach tax system property page.*
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<br /> Tax ID#(1-5 digit number;found on tax statement): 1 a.0
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<br /> 'Proposed Use of Structurc/Addition
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<br /> Anticipated Start Date:bit 12, (Home/Cabin;Commercial Business;Beihatnn;Deck;ac.) NA -3
<br /> Building Contractor: NM Sewer Installer: 0
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<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
<br /> /INV construction taking place for any dwellings,dwelling additions,maintfactu red hontes,manufactured ......
<br /> home additions,and bunkhouses.**
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<br /> 0 1-1/Al pfl•" 174 1,1C.A.4de5 WIC, CleCle, •
<br /> Check#: 10.10/
<br /> Date of staff site visit: 6 Z 2.4920Z0 Initials of site visit staff:
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<br /> ( APPROVED BY LAND SERVICES OFFICIAL: DATE: J
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<br /> UPON APPROVAL: APPL CANT MUST POST COPY OF
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °.
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<br /> C,,m467 re Page 1 of 5
<br /> ef.X WI • n -10 7
<br /> Burnett County,WI Land Use Application—Rev 05/2022
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