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c, ro - <br /> LAND USE PERMIT APPLICATION - Burnett County, WIg. <br /> N <br /> Applicant Complete All Sections Below This Line c ca <br /> Permit Types and Fees(Please,check appropriate boxes) a W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F, ~ <br /> Commercial/Industrial Structure $30 Addition/Alteration to Commercial/Industrial Structure $200 &_ o <br /> Accessory Structure(Garage,Shed,etc.) `$150 Addition/Alteration to Accessory Structure $150 N g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 '�J <br /> Filling/Grading $150 Boathouse $500 up <br /> p <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 �_ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. C•') <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. i` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -. <br /> z <br /> Property Owner's Name: A'14 6 ii3 v t,6- sit p 3 0 fo <br /> /- 0 <br /> Property Owner's Mailing Address: I(.0 S- Da 801.$ i.6IN P a y?" -- 15tnpu ar-r <br /> City State Zip <br /> Property Site Address: .6 i4 "l <br /> o <br /> Contact's Telephone Number: 7 / S- 6.3 S---' 7 / 3 p- <br /> d <br /> Contact's Email: �4.-iacfLG3c, f 4 V p1-1-0v• c:t -ram <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: @BurnettCounty.org and °Q <br /> @BurnettCountyWl.gov E. <br /> Legal Description of Property: I.) i/z N if_ NW S w 5 , <br /> Section#: '3 v4 Town#: C.61! N Range#: ( 4 W Town of: j6 ? 'r <br /> 2z--) i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* s x <br /> Tax ID#(1-5 digit number;found on tax statement): 1 '2 )L.. <br /> Proposed Use of Structure/Additi S F S 7 A RG E GU <br /> Anticipated Start Date: r <br /> p � l ( 2-, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: .- 17 Airy' <br /> Sewer Installer: 6'`''. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUB ECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 0 afieZiv c, 1 e--bcu,k(S <br /> IJO -co/ ha0450l kbl ico �L <br /> 3 kQtield at/ Lr.Yc , � t L V p" (3 - <br /> J� x Fee Rec: /5:7) <br /> 5 o Check#:?j .,0Q <br /> 151 Oil �n5 Kees 5 i3n eem2, /�/ Of /;-3tn <br /> (/ a <br /> v <br /> � . t- ---� �J <br /> Date of staff site visit: 2116/2-_3 Initial of site 'sit staff: ��1ij Al <br /> n <br /> 't'1 ; <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: al/7/23 r , <br /> v, <br /> O. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 2 l° <br /> z c1 cr.; _ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT n ED.4c— <br /> Page l of 5 < 3 FR <br /> Burnett County, WI Land Use Application—Rev 12/2022 d I I JJ <br /> H <br />