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LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> b <br /> Applicant Complete All Sections Below This Line Ei <br /> B w <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> ,, <br /> Dwelling/Principal Structure ,$300 Addition/Alteration to Dwelling/Principal Structure $200 - <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �b Fs- <br /> . <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> NI q <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 c <br /> Filling/Grading $150 Boathouse $500 cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 z• II <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> -0 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a �' ik <br /> !� z <br /> a <br /> Property Owner's Name: _9-2_0 g..IJ L- M o <br /> o <br /> o. <br /> Property Owner's Mailing Address: 395-3 (IK/N c22C-C-X -A NgK/41 W( 5Jo <br /> City State Zip ° 4 p <br /> Property Site Address: 3/53 vile-/N6 CC Doti-iv Act �! SYS'Y© • <br /> Contact's Telephone Number: (lir) 2-5 9 - ? 3 I Z ° <br /> _ d <br /> Contact's Email: .52 mitres c?Cf N Tt fZ % t.- . N £ f <br /> **If staff has a question about this application,yoi3'will be contacted via email. Make sure your email address is N ,,y <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o <br /> @BurnettCountyWl.gov <br /> ,� o <br /> Legal Description of Property: L o-r -2- V(K/�6 Hra-ADDe I T Ai Tr> Va34.i.M v//�o(c� <br /> Section#: -3 Town#: Li D N Range#: 15 W Town of: G '1 cJCk5o cr <br /> *Attach additional page if needed JO,.lengthy description OR attach a copy of the deed OR attach tax system property page.* g) o x <br /> ° <br /> Tax ID#(1-5 digit number; found on tax statement): 886`f W <br /> Proposed Use of Structure/Addition: 5 e CodOl-- <br /> H C7 <br /> Anticipated Start Date: 51( (Z 3 tJ !Horne/CaAin Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: TA,J 5$A,S R. CP <br /> a r4l ) Sewer Installer: toil <br /> z GAREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY � <br /> Tins PERMIT Ic SIT TFCT TO Al T CONDITIONS LISTED BF, OW: I,` 3 <br /> rilizeri- q(I 5��'CJci cJ�5 v' <br /> /necit ktii:174'07/ <br /> OD <br /> gsef,44,, -I-o �e 5elr�/t C 6 f I! o?3 cog ` jecli/� 1:Cdl[P.rl zFee Rec: <br /> �4`� <br /> � C h eck#: � <br /> Of m <br /> m <br /> r. <br /> z <br /> Date of staff site visit: 2// / ?3 I ' ials f sit;vi staff:d1I <br /> ' �II7/ 3 w <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: v, z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,o= N <br /> Page 1 of 5 • <br /> 3 w <br /> Burnett County,WI Land Use Application —Rev 12/2022EN <br />