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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line °, CD N <br /> Permit Types and Fees:(Please,check appropriate boxes) n' J <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 j 0 <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 /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° �J • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 LV <br /> Filling/Grading $150 Boathouse $500 ► • <br /> v) <br /> 11) <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. or 0 ,yam <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> f `` //�� / -n Q <br /> Property Owner's Name: ��/�/ 7rJQl� � /(�j�r/p //�L t/ ,, <br /> -�Q/ 9 F. <br /> Property Owner's Mailing Address: - s 4lf CA !� al�/[,,�V City State Zip <br /> Property Site Address: i : c <br /> Contact's Telephone Number: 62 " ! 'it/" `-7` 0 (-/h/tA /) d <br /> _ ,�^ J/ CD <br /> Contact's Email:ill/CA de Iar'ry 7 a) 2rY1a/ I. Cori 0 <br /> (- / 1 � 9 l <br /> Lagal Description of Property: �Srn V �� / f' !�� F <br /> P <br /> Section#: Town#: (We N Range#: W Town of: 5.-(76)4/ 72, *.i <br /> a. <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): 3L1800 o H <br /> Proposed Use of Structure/Addition: Gm / La/Z.1 kwAl/ iP S -- la a- r7 <br /> r7 <br /> Anticipated Start Date: Vila' ZOZZ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:Etim ¢tn/ 6fn,ca/.5""cliivt7 Sewer Installer: (~ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> po <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 additions and rya 2 **i � e��- a(I 5e� acc. �s cPn�d be- rt, ievV� <br /> Qe t'e�At/li� W��, emu'' 1�l�uh kore1322. 5 t°ct4" i e /b3 FeeRec: l�J <br /> UQ�rpd renew <br /> C b .S P Check#: ?70,ro <br /> 1 - <br /> I ?l']_ f d <br /> Date of staff site visit: I;( 1JI v Ionia s o site visi sta "1 <br /> ^� 8 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:`I °�� //'2 L i ', f <br /> UPON APPROVAL: APPLICANT UST POST COPY OF y Q � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w m < �? <br /> ifiiii <br /> Page 1of5 n m = a <br /> Burnett County, WI Land Use Application—Rev 05/2022 a.< N <br /> m <br /> cn = 4uuu <br />