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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> a <br /> t. <br /> b <br /> Applicant Complete All Sections Below This Line 0 c N <br /> Permit Types and Fees:(Please,check appropriate boxes) °C7 l v <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD N.1 <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 4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e 'p`` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 • <br /> 0 /V <br /> Filling/Grading $150 Boathouse $500 <br /> to <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <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. gE. , !; <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 1 <br /> Property Owner's Name: Te((J cold fp/Ida_ LQ (sen 0a. u <br /> Property Owner's Mailing Address: a 7 5U a Lee 7oaGf Wabstern Y,T ✓V i i <br /> City State Zip <br /> Property Site Address: N °+✓.PA i 2l► ,0 G • <br /> Contact's Telephone Number:'a Vis.D *1,S ` rj6b -2-4\3 S- d %1 <br /> Contact's Email: \Cq d O ?etff.NsOILA.0 1 Ih/1A%1 • LOQ <br /> TAC Sc.t.,c: `tr hit o f Ylle Sr/4,4,�.c f�t[G� 't c` / S�v ve-oaf- 0 04 <br /> Legal Description of Property: Q'''.1-cC s z y S[ yc uc.hr.� Bi � Z& ,lowlw� S't7 tU�'tth, 12us� cio <br /> J t:L.2I ti��-ci7) ,Wes?� I LR.✓r,v/ttit.CL ' r_E-l./ (Ld <br /> 'L-t,iay) Lit - <br /> Section#: .(D Town#: 1-0 N Range#: 1 7 W Town of: IA n I 0/1 D,' _� <br /> n m ` <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* h./ <br /> Tax ID#(1-5 digit number; found on tax statement): A ,5 / V> H H <br /> Proposed Use of Structure/Addition: �O fY)�. . 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) H (!.. S..) <br /> Building Contractor: Pe lfr'ot'! eGYI S -Cl Ch vn Sewer Installer: /Ark//Ii SAni fi Gra VP/ 01 <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 /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> ho a additions, and bunkh uses6.*sl y 1ee-4- aL! 5e ( I-I� s oer Sf�N- ?? - I " <br /> lt;/ 49.1 .'O Q 'uU 3 be 1 Fee Rec:�('�IJ— <br /> 3 �;re �1 r ;S ( 14 1 1 >! a` Check#:i to-7 <br /> o <br /> 8�?5 / o <br /> Date of staff site visit: Initials o site visi t f• / tn <br /> D <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: "PP' DATE: q111?-02 <br /> 1, <br /> UPON APPROVAL: APPLICAN/ / UST POST COPY OF a CO- Oc C g <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> --<< O C hJ C <br /> Page l of pz 54,< Paa <br /> Burnett County, WI Land Use Application—Rev 05/2022 < cp <br /> N <br /> m <br /> ocA LL <br /> 3 <br /> b <br />