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, LAND USE PERMIT APPLICATION - Burnett County, WI a " <br /> r <br /> k• b <br /> _ Applicant Complete All Sections Below This Line c <br /> CD 1 <br /> Pe, iit Types and Fees:(Please,check appropriate boxes) n. <br /> m <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V n <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 Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse $150 0_ f <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 :t: <br /> t ) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o *v <br /> 1-SolFilling/Grading $150 Boathouse $500 (1- <br /> Sola r <br /> ar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> E <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. r; <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. o g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ),...11 <br /> V .Property Owner's Name: c c-'1 f--" Op�4.�Q'� a, N <br /> Property Owner's Mailing Address: eJ 1-10. ` A°/C- <br /> City ,,State Zip d <br /> Property Site Address: 9'R J 5 k net.10-- -'� (Lk- '0 G(' r 4 ' V)I_ E -%' ) o c <br /> r �' _a <br /> Contact's Telephone Number: (051- -70 7 - ✓b G o S <br /> P.' <br /> CD <br /> Contact's Email: \o C C*,rl_ R, l2-c D Pt i_co b <br /> N <br /> --'0 (0- '---;f0 5' <br /> Legal Description of Property: , `,'� ao d <br /> Section#: % Town#: q ( N Range#: /6W Town of: SIS/r d <br /> 5 5 P <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> , JJ ��ll cn <br /> 2 2Tax ID#(1-5 digit number; found on tax statement): ✓i t V1 o :v <br /> x <br /> Proposed Use of Structure/Addition: 0,20 ( vi ' ''‘ t7 <br /> Anticipated Start Date: (1 - ' ` c, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t ". ^` <br /> Building Contractor: • ^ - ) Sewer Installer: %1` i ' �') 5��)�h�1 °('l'1004.5 <br /> V\ `V <br /> (V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z w O <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 il- • <br /> Q0lZghome additions,and bunkhouses.*i <br /> I' A�J170 TZ- `�. <br /> /6 �iu c-1 „e. /S 0HfYVIP 6 e- U S'Ct/Q SCts <br /> At 4 <br /> L✓(Ill /p Ho UC / ' vY u tina�! D/747e41. 41Q� <br /> R <br /> oa <br /> /UOf K5- be m�f t1" s�j�'�2—Z/a• ci/ Fee ec:: :t . � Check#. <br /> of staff site visit:(Date <br /> /2 D ?.d Z.,2..... 71 (2) �Initials of site visit staff: / `� <br /> rn <br /> CD <br /> APPROVED BY LAND SERVICES OFFICIAL: N. LDATE: �ZOZZ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF co GI C'; <br /> m <br /> 71 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 �; <br /> 0, � ZNS ec-,4�' 4'174//1 6141"7' ,QeCtg �VI-a/5 <br /> ' S <br /> ��/a �dL / page .�___�_ ._._�' <br /> Burnett County, WI Land Use Application —Rev 05/2022 T' �---jj <br /> 0 r✓Idt�e, Su�^e- 7 ma <br /> q// 5 e9-4Q,s if /$ a Ay of si' . <br /> 0 I's pe,vs-AIT is it, 25x $o Left 8,x to row, <br />