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A . <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 0 <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 $, Addition/Alteration to Dwelling/Principal Structure309 lT►\ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °r. <br /> w <br /> Filling/Grading $150 Boathouse $500 l; <br /> Solar Panels (Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits ermitconstruction has begun)may cost up to three times the normal fee c <br /> *Communication Towers&Signs require a different application form;see corresponding app lcarlon,inldf 1 . g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ` <br /> Property Owner's Name: /✓� �//J W <br /> • , <br /> ad"' -0 % • <br /> Property Owner's Mailing Address: ���j� �y a Az �—r ' � <br /> City State 2.Zi � <br /> Property Site Address: Z 9g f/ 6 ! 2 'n6lcYy 4'!1/ _ a <br /> c <br /> a. <br /> Contact's Telephone Number: 6c1— 3 3 if-- 75 s z - d <br /> ro <br /> Contact's Email: .7.- - 0 IOL//v& ©T/sl9ff/L- , t_0,t4 oN <br /> r\ <br /> SSE v�T'Ti��fii�� .S -�'ha� �p►T =. <br /> CP <br /> Legal Description of Property: UN <br /> Section#: V9 Town#: q C' N Range#: I L W Town of: $c p,A1 Z <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page* ^ <br /> Tax ID#(1-5 digit number; found on tax statement): g . -- f <br /> e <br /> Proposed Use of Structure/Addition: j�p/lf�`�s'lt'S//✓e 5$ d <br /> Anticipated Start Date: DCA G (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —3 <br /> Building Contractor: a t.--�= Sewer Installer: �jr/S774JCT-- sk, <br /> tom^ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY V ` <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 them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** a r <br /> d ►'11ee� G ( CiP�nf yx6 re ,re,ytc�1 i3 <br /> �y f <br /> G� i'ol lOw cc 1( CC7r✓I KO er4'a) re c4;et'nC� I T Fee Rec:.�m=a <br /> gl :S pore l+- i5 under 5e.c. a- 77 'r, S vp 411 dJ y Check#: ar�r-) <br /> 0 5441:5�,me cu,n( nmt/- 5e rqil:4 . <br /> Date of staff site visit: I �` 2�l�ce- Initials ite visit staff: Ht .4 � 1 9 <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL: '1 DATE: 21 9 I�22 J m gff a O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 7.., <br /> °ED C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT zoo w <br /> •{ a <br /> Pagelof5 m a '" <br /> Burnett County, WI Land Use Application-Rev 05/2022 245 <br /> m L <br /> O I:.., <br /> H <br /> ..J <br /> i <br />