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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Applicant Complete All Sections Below This Line c N <br /> n 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 x <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 - r <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 2 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 c Q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S <br /> Filling/Grading $150 Boathouse $500 <br /> 10v <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 S� <br /> _ <br /> t4 .a ,1c— <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z 3 <br /> 0 <br /> �' /4W �� -- P. <br /> Property Owner's Name: RCi)'LI.L� e�Tc �kLjt'7 C.k <br /> Property Owner's Mailing Address: 015 BI,I, hhe. Rd > C �'' um 36 <br /> Late <br /> ,r,J City State Zip c <br /> Property Site Address: �q E,R(,lp't1�t� LaX.e �iv� x�r W i S �j ? A <br /> JJ Q <br /> Contact's Telephone Number: -7/5---7,33'bad 0"F <br /> Contact's Email: aminek Q n .JL. C +M vi <br /> Legal Description of Property: Rner►�u ,e p res Lc - 4, 4 N661 Lot 7 <br /> _ <br /> Section#: f Town#: 140 N Range#: H W Town of: &-cliff" <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F <br /> cn <br /> Tax ID#(1-5 digit number; found on tax statement): felas-] o w <br /> Proposed Use of Structure/Addition: (araot,/5tciaG 70 0 <br /> Anticipated Start Date: 6j- ,2 J (Honre,Ca rn;Commercial Business;Bedroom;Deck;etc.) 1 H <br /> Building Contractor: ': Sewer Installer: r/4 I W <br /> csi k5 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zN <br /> **The applicant needs to contact their(DC Inspector to determine if a permit is needed front them prior to x --J <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> 0 4101- O he u se-c e li g i Aa p1 A q b il-c J4na <br /> Fee Rec:"/I50'°U <br /> Check#: as I a`f <br /> d <br /> Date of staff site visit: V/Z-/2-0?-2-- Initials of site visit staff: )/ .--- ,1 �,� .., <br /> R <br /> 1—_ <br /> APPROVED BY LAND SERVICES OFFICIAL: , _dampDATE: CO3,202 Z I, ,,7 <br /> at. <br /> Uuu <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF r4 a © <br /> EA <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT7 crl <br /> g c: <br /> Page 1 of 5 S' Ill <br /> h <br /> Burnett County, WI Land Use Application - Rev 05/2022 - L J <br /> e <br /> A <br /> K <br />