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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ° cn EnN <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> 1:,)- <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 o W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' <br /> Filling/Grading $150 Boathouse $500cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P. C`1" <br /> r <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. g. <br /> \ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> L.n�,rr.J iProperty Owner's Name: �� g.A2.AJ ,71, <br /> Property Owner's Mailing Address: 5'9 ,6-4_,,,f9/1 4_ `' �!`�lG�c � 242,'-� 2> '' \ <br /> City State Zip c <br /> Property Site Address: OCC./yj,C <br /> a <br /> Contact's Telephone Number: 2/(S---5'2 6 —2 c6._5 SC> o <br /> Contact's Email: ,/,2q/07¢.„,/p RC2)/Qi/'6D yp o. C A3-r� "0 UDD� <br /> Legal Description of Property: NC. IVtrg <br /> g <br /> Section#: 33 Town#: 3 0 N Range#: i LI own of: De Gd F y 3. <br /> *Attach additional page if needed for lengthy description OR attachattta copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3� I <br /> Proposed Use of Structureddition• - <br /> Gi 4 X4a , <br /> Anticipated Start Date: q... c,p (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H if L).) <br /> Building Contractor: Sewer Installer: - - @ S <br /> E <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 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 pJ <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured <br /> h i e additions,` and bun hou es.** <br /> I Ol ec.—a(( r 5E�� Cd <br /> ry °`� �D A oO b� 1� r�K� V� Ftioii+- b �a1���� = Fee Rec ?00tpr - Shec( ✓ite 5 c.n rn.6G5Sd `Jl Check#:3C b <br /> pp�� o <br /> Date of staff site visit: YJJ/&l a'?- Initials of site visiit t ff• '. <br /> / p y z npn�n� <br /> APPROVED BY LAND SERVICES OFFICIAL: 21._ _ . i AL,I' DATE: of I7//� o PU1 m <br /> UPON APPROVAL: APPLICANa`MVIUST POST COPY OFo p.cv <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTu <br /> vco w <br /> Page 1 of 5 K a <br /> J <br /> Burnett County,WI Land Use Application-Rev 05/2022 ED <br /> Y <br /> 3 <br />