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LAND USE PERMIT APPLICATION - Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line O' N <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> e Crt <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .� <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 b <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 A < w <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 .'‘'‘ o <br /> ^ <br /> Filling/Grading $150 Boathouse $500 <br /> 4 <br /> Permit Extension(1Year Extension-Allowed Once) $100 — <br /> w <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. - , <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. a 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> 6. 4i <br /> Property Owner's Name: 6si?_:, 4 L15A ??,)cz1 b <br /> Property Owner's Mailing Address: 2-% ° 044C ANL 1' V% , i-4449:014 MINI 4'5 " <br /> 22 r� 1' 1 City t1 State Zip C <br /> Property Site Address: %3s L- P)1►J`%$ Grv0 o 1 Y�I(�itfE12.- , �( I 6k109s #� o <br /> a. <br /> Contact's Telephone Number: '" TOY O YW 4 d <br /> a <br /> .. <br /> Contact's Email: 1FQ R.) , 9,..01 € '{'c4 r 00 CQr\ N .0 <br /> 0. <br /> Legal Description of Property: 1AZ 'i 4 S SSS i 10 3 ‘304-3 <br /> 2 d <br /> Section#: 3 b Town#: O N Range#: i 1 W Town of: U N I ONf <br /> i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cA <br /> Tax ID#(1-5 digit number;found on tax statement): 2.-9--1g1 VI H X <br /> //�� Cc � ° e <br /> Proposed Use of Structure/ ddit' n: c%l�A ") <br /> Anticipated Start Date: 9 ol y <br /> p I l} "L� (Home/Cabin;Commercial Business;, Bedroom;Deck;etc.) _� <br /> Building Contractor: O11JJ,Jv -- Sewer Installer: Nqp '-. <br /> rx G S <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY '-'" pQ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: x S <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> _ /VY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> © /1)°f 1 k used -r- Au—tliabi'74:04 vl., <br /> ..q Fee Rec:/520 <br /> x <br /> Check#: —19 <br /> �— n d <br /> Date of staff site visit: VI02- g� Initials of site visit staff: y)// /)1i/ a <br /> APPROVED BY LAND SERVICES OFFICIAL: 411111111111° DATE: //0-.0°-Z-- 1- <br /> G M <br /> UPON APPROVAL: APPL 'CANT MUST POST COPY OF l' fe W <br /> Z3 GI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N f3 <br /> �g o <br /> � Q <br /> Page l of 5 3 ry ^ <br /> Burnett County, WI Land Use Application—Rev 12/2021 5a <br /> ro <br />