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~c r <br /> LAND USE PERMIT APPLICATION-Burnett County, WI g b <br /> . N <br /> Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> c <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ry <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <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 r- <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 = ' <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. r- P <br /> *Items net listed above will be treated as accessory structures,� such as:pergolas,landscaping,etc. _ 9 <br /> e Property Owner's Nam -1":". <br /> •- Uri/1 0 .. <br /> E. <br /> Property Owner's Mailing Address: ) ID.? Cod ctQr, oc( l.- I r SHAtopee , MN 55377 ' n <br /> 1 City State Zip <br /> Property Site Address: NO Acktked,'?" ` <br /> 5-- `14(WA" ts,G,410 • Y <br /> a <br /> Contact's Telephone Number: tp Z�� '''1 — Cam, -�� d <br /> I" ',! iv' <br /> Contact's Email: eJct(f e/tOr c.k& T U 0' C06/1 oN - <br /> Legal Description of Property:NC SW 1 r' bi y of T Rd C rbt Ft-d c&c( 3 I k) • <br /> B <br /> (y �/ d <br /> Section#: b Town#: 7d N Range#: /,- W Town of: 3-QG1 -5c7 1 z. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* <br /> oo <br /> Tax ID#(1-5 digit number;found on tax statement): °.SI q(e a <br /> �� /� t3 <br /> Proposed Use of Structure/Addition: �l vP'r'off=' ecwkicttAt"Yl./ I ^, op <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) I_ �� `J R <br /> Building Contractor: Sewer Installer: HA v ' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ..,,co <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z N <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to ••' <br /> ANY construction taking lace far any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions,and bunkhouses.** <br /> 6 , ie/r-e.- sole 6 e c;l-/e-- 'S7 /e Awl ne07% 1.9r'r/d <br /> /i tile,. Fee Rec: /5-060 <br /> 4 �y -Ce�jy, q s/y`C G(9 �12° ss 6y 3//�z3 = Check#: i`t`��t1 <br /> IS) NG� P�° / Elea - trSet <br /> Date of staff site visit: /O/7/2.d 2-Z Initials of site visit staff: �/T/ /�,T n <br /> /// z <br /> APPROVED BY LAND SERVICES OFFICIAL: )AI E: /D//D/ZO L Z 4 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o CD W CD <br /> 6 KeaT 1)NR 7U SPA ( c aNpe QPe /'le-cc/e Page 1 of 5 y <br /> Burnett County, WI Land Use Application—Rev 05/2022 <br /> r ��L s�Q�us. o .< N Ci <br /> b <br />