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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> cApPlicant Complete All Sections Below This Line ° w <br /> (v <br /> , <br /> Permit Types and Fees(Please,check appropriate boxes) da <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 4 <br /> Accessory Structure(Garage,Shed,etc.65Y>1. Addition/Alteration to Accessory Structure $150 <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 g' <br /> Filling/Grading $150 Boathouse $500 N <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. 4 co <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ( 9_ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' "' <br /> o <br /> Property Owner's Nam: K eeu� . K 1 e f1 c L 1 0' IN <br /> Property Owner's Mailing Address: 1 Z�10 5Q n b�rN VJ e, Tzr WI 541 j c <br /> �J � N <br /> nn � yy Cit State Zip = W <br /> Property Site Address: 9 Z1 C� SP cJ 1�,i11. W'Qts-ter', L1/ 5` e93 c <br /> Contact's Telephone Number:(i i 51) 5 &6,— 27 31 a. <br /> d <br /> Contact's Email: ?<p eel c...) kc: i 1€Vein Se s M ,r(. Cc -) CD <br /> **If staff has a question about this application, ou Ali be contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q ,.fl <br /> @BurnettCountyWi.gov <br /> p <br /> Legal Description of Property: q 2.10 5 p.,n. -3 0. 3. <br /> (Al <br /> Section#: 03 Town#: 3 5 N Range#: / 1 W Town of: 0 ctfl i e i t 5 N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N o .-3H <br /> Tax ID#(1-5 digit number; found on tax statement): I B 53 <br /> Proposed Use of Structure/Addijio G c.re,c e <br /> P <br /> Anticipated Start Date: Co m. to J (Home/Cabin;Commercial Business;Be room;Deck;etc.) <br /> Building Contractor: keel k n Wet I t QMSewer Installer: /V / <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVS STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> - ALL+ aGf ;thoa S --.' ���� <br /> �r �,lln 4r0 <br /> N -` IrtU V\ ►ilk(/M + -3 Fee Rec. '�" <br /> c Check#: 5X <br /> m <br /> 0 <br /> Date of staff site visit: 2.I p/2 C)2.5 Initi of site visit aff: YE E + 0 m Tiii <br /> APPROVED BY LAND SERVICES OFFICIAL: : Z/ i/� <br /> 111 m m o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF $g a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' 4 NI <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 <br /> a <br /> , <br />