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LAND USE PERMIT APPLICATION — Burnett County, WI b r <br /> 3 <br /> N <br /> Applicant Complete All Sections Below This Line '' w <br /> Permit Types and Fees Please check appropriate °yp f boxes) 13 <br /> ✓ Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .. <br /> Accessory Structure(Garage,Shed,etc.) $150 -Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �? 3 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ._ <br /> V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> o <br /> Filling/Grading $150 Boathouse $500 ' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 QA— S <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. N `. <br /> -o <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application, and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 '- <br /> z p• <br /> Property Owner's Name: MA 12-14-AL do &1'.f6%.CY M /24E ( of.' o z A <br /> o <br /> Property Owner's Mailing Address: J 1 f,3'/ W4 �t41.1- ST PIE , M PI 55304 b l <br /> City State Zip "' <br /> Property Site Address: (0 03 MIND W� ,2s 0�4-p 1 S//Z � ►n/I 5767'�--. ` o y \ <br /> •// i c <br /> Contact's Telephone Number: CaZ• S 0/• 8 9 �Q q 2. 1 <br /> Contact's Email: fr1.SL/�0,1 e f 0 /4, -I C. . �M ro �' <br /> **lf staff has a question about this application,you will be contacted via email. Make sure your email address is N - -n <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and z °' <br /> @BurnettCountyWl.gov d .� <br /> Legal Description of Property: LO�7- /q C 5m ,213 VD1 ?0 P 13 q tercL Dec 1(o 473 '. <br /> Section#:. -- <br /> � Town#:✓_/ N Range#: /tO W Town of: 4 it-N 0 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): 35.. 2-. a d <br /> -, W <br /> Proposed Use of Structure/Addition: C-Ab1 4 <br /> Anticipated Start Date:k4it PLO 2.0 ,3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) w TM Ul <br /> Building Contractor: SCLF Sewer Installer:WATX 12 OLM <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •Tee- cl( se1bctc(ts <br /> r)wel►i not eccee4 3 becrrx" VVV- 21 -a7ii <br /> © � - c II/ l415 r �� 7) u, x Fee Rec:3C.XQ <br /> e i;c e4ce� 'u✓n b 6 Check#: <br /> l (►/lUs1 Ce►�/tc �-v5�4NS�S 7 <br /> rrl <br /> r. <br /> i'D <br /> Q / <br /> / <br /> Date of staff site visit: I!1 U -3 Initi s of sit visit staff: uE +kt I `-- J� � <br /> 2 <br /> n • <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: P17/a 3 7, °- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <5cn co z - <br /> -< a roll <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD " w Co rrin o <br /> Page 1 of 5 m C'� cw <br /> Burnett County, WI Land Use Application —Rev 12/2022 3 N <br />