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LAND USE PERMIT APPLICATION - Burnett County, WI c g <br /> a <br /> b <br /> cn <br /> Applicant Complete All Sections Below This Line o N <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> A �:y <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -o ` <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n n1' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> vi <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. 0 <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. r g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z \ <br /> Property Owner's Name:1.)vr,„k 4-0....kk-ri (`QQe('S o. <br /> ET <br /> Property Owner's Mailing Address: 2D 25 Pal) g La.Viz (eL 550)8 J2 <br /> n _ City State Zip C `! <br /> Property Site Address: /p3O (�v rcF i , & SDw/1�r^, ev. 5 y$o/ <br /> 61Z y/ 5g2..7 a <br /> Contact's Telephone Number: '1 c <br /> Contact's Email: `D e.re k at)I rOc\ecs ) rt a,j I% Cpi o <br /> cro <br /> Legal Description of Property: LOT y t 5 fr\* '/W Y25 P2.07 g. <br /> o D <br /> Section#: Z.41 Town#: LiDK 7Range#: /y C.,O W Town of: S TT r ,J <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* �' <br /> v) <br /> Tax ID#(1-5 digit number; found on tax statement): 3'1 2 21 r <br /> k,H <br /> Proposed Use of Structure/Addition: 5TO{Zf1f�FJ d <br /> Anticipated Start Date: A$A' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) y W <br /> Building Contractor: S el f Sewer Installer: iVA `r's <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from theta prior to 1 <br /> ANY construction taking place for ant'dwellings, dwelling additions, manufactured homes, manufactured <br /> home additions, and bunkhouses..*)* <br /> ,yt era- a0 Se p- -h urt <br /> N4-(o 601.4•4 Jt& 6) <br /> Fee Rec: <br /> (42 <br /> Check#: 5-7 3/ <br /> Date of staff site visit: I(1 a/ -1?"- Initials of site visit t Zrnr <br /> z <br /> CiViAPPROVED BY LAND SERVICES OFFICIAL: DATE: I (/q12ir '-• �-- <br /> r <br /> < <br /> m <br /> UPON APPROVAL: APPLICAN UST POST COPY OF a a W € <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o g a ! T <br /> -< v <br /> Page 1 of 5 `� e�i <br /> Burnett County, WI Land Use Application —Rev 05/2022 s <br /> rn <br /> v <br /> cn <br /> Q. <br /> a <br /> b <br />