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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) _ �� <br /> Dwelling/Principal StructureO <br /> $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Accessory 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 6- <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 _ 1 <br /> Filling/Grading $150 Boathouse $500 )J b <br /> I Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 = , <br /> *NOTE:After-the-fact permits begun) <br /> (permit squired after construction hasmaycost upto three times the normal fee. o <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. -- <br /> Property Owner's Name:l '''\\C_rPs 1_ &0 a C�A T.: <br /> c <br /> Property Owner's Mailing Address: 2It 5-3 i K\ 2b ca t W( 4{'8'--7( g. n <br /> ,� 3 / City State Zip <br /> Property Site Address: t`-l f V 6 l E lse \ '5 .-7 1 <br /> -7 _ <br /> Contact's Telephone Number: 1 l S cl i C1 2-c 9 8 Fs <br /> Contact's Email: 11/4A kL J 3 '7 TZt. 6) C.43NsT) Ct ZS(Z . Nei—t- <br /> Legal Description of Property: S 1_ \ V S 1? 5 ) <br /> u. <br /> p y� C 3� ��•.►� <br /> Section#:S D t Town#:13fi N Range#: R A 4 W Town of: DEAN E 4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page • <br /> Tax ID#(1-5 digit number;found on tax statement): 2-S7' ' <br /> Proposed Use of Structure/Addition:EY-timC�-tJR l/.�yJb� \tiISThc..A?1rN 6(ia;a© 4 -6oao O = c <br /> Anticipated Start Date: C)GT. Z 0 2.2. /Home/Cabin;Commercial Business:Bedroom:Deck:etc) <br /> Building Contractor: NI A Sewer Installer: NIA1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Ni <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z "-.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 /> home <br /> l''additions,�f �(I <br /> bnnkh1-b <br /> Fee Rec: (`DU`A <br /> Check#: 1D'72) <br /> I I /7f2 . <br /> Date of staff site visit: initials o ite visi <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ll / / ( �/a J �� <br /> UPON APPROVAL: APPLICAN ST POST COPY OF 1 a7. 1 <br /> M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g <br /> w <br /> Page 1 of 5 z goQ <br /> Burnett County, WI Land Use Application-Rev 05/2022 N.) <br /> ENO <br /> m a <br /> a <br /> c <br />