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LAND USE PERMIT APPLICATION - Burnett County, WI e <br /> Applicant Complete All Sections Below This Line 0 � 1 <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) I .. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ° 'J <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> a <br /> Accessary Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> IP <br /> � <br /> De /Stair atio/Retaining Wall/Sidewalk><1 0 Bunkhouse $250 <br /> Driveways/&Campground Structures WI State Statute 59.692(1v)Structures $350 �'. <br /> Filling/Grading $150 Boathouse $500 Nb. <br /> w ii <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g 14 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> o <br /> Property Owner's Name: ` L 1-3-N1 b Et- *11 <br /> ° l <br /> Property Owner's Mailing Address: <br /> 24l.Db4 v Nl1 Q 1" ' T L Jar Ni 4 Acki rt l 550414 <br /> City State Zip E <br /> Property Site Address:22(pG L{ 4 n-N56K-IS 1 t•-tz' 2,13 • <br /> Contact's Telephone Number: Li)6 -2. 1 8 ^ t0 6) 9 a <br /> "" n C7 <br /> Contact's Email:(Wctmi chelehc nseI (pG�J 9mctt ) • LOIY1 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and 0 °0 <br /> 5" <br /> @BurnettCountyWI.gov Do <br /> d <br /> Legal Description of Property\ rPrN Sd N.1'S c 1 N C Lot 3 <br /> P. <br /> Section#:S �J1.-'1 Town#:3t N Range#: 18 W Town ofA>s. C (2-IN t12. cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c )l <br /> Tax ID#(1-5 digit number;found on tax statement): 2-Ci 6O C <br /> CPs-l R.S <br /> Proposed Use of S'huchue9Addition: <br /> Anticipated Start DateAf2cl 12 TV1t P C_r (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS( 5 SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1( Se1b4c <br /> Onlee�- a ( �. r<r� e-�-� 1��� us e �° <br /> 00 eA , nest( road /feeds nee+ 5 c 5 5 <br /> cm I- b 6/11 �C/'t�4' ✓h•'� 1 y 311 J/2-3 t,T W '' y Fee Recp1 �7•50 <br /> 6 e�ts 1�' )Gr ao Check#: C.i <br /> rent ,nor' -a.ri to To-kl i s ,^ 0. ,ePec- m <br /> i v �' <br /> �✓ <br /> Date of staff site visit: 1112-i 3 Initials f site visi staff: ] 1 r 1 ' < ur, F-- <br /> APPROVED BY LAND SERVICES OFFICIAL: � w4� ' DATE: 1/ 7/a-3 r,,,co <br /> t § ' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z CD INJ <br /> 6 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 <br /> Page 1 of 5 < CD <br /> 1 <br /> Burnett County, WI Land Use Application-Rev 12/2022 u C� <br /> a <br />