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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> . b <br /> Applicant Complete All Sections Below This Line o • w <br /> a. <br /> hermit Types and Fees(Please,check appropriate boxes) ,-.-- z 0 <br /> Dwelling/Principal Structure .dc $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure -FS' $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> A Accessory Structure(Garage,Shed,e��1 . Addition/Alteration to Accessory Structure $150 <br /> 54 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° }U k ., <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �' w ' <br /> Filling/Grading $150 Boathouse $500 N <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. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> •• I Property Owner's Name: KQ.IST1 L. tb l..&0 i 5 1 0 "1 <br /> a. <br /> Property Owner's Mailing Address: l to(0 014-5 ( it (c e L P4 tJE 6STE1Z c..)t S`f S 93 n <br /> City State Zip ° `" <br /> Property Site Address: a(oSes' Cta5(3_„Cre e_k_ (L Gj P�S T er W ,;`i t y 4 3 < <br /> N <br /> • G <br /> Contact's Telephone Number: 7 l..5- `f 3 t' i 3 4 $ a <br /> C7 <br /> Contact's Email: K Lb 4 601S al.415--@ LO+IM.Cx.i. I . CO"ex <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> o <br /> @BurnettCountyWl.gov oo <br /> d <br /> Legal Description of Property:See.cb 8 Tn 3 9 Rg t f ,J w ,viz Ex S l00 I E. <br /> Section#: OS Town#: 3 9 N Range#: l LE W Town of: R k$K. v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* 1 F <br /> Tax ID#(1-5 digit number;found on tax statement): 1ST(e$5- • ay <br /> Proposed Use of Structure/Addition:n� 5+ora e_ Le..rae era Pro tc.13 <br /> Anticipated Start Date: 1 '`- - (Home)Cabin;Commercial Business;Bedroom;Deck;etc.) Fil 61 <br /> Building Contractor: Sewer Installer: ( (% <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z v 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Lm-1- <br /> eeA__ G (( 5eq)a JAS.-6/ kunt4A i Q b, j4.v4 <br /> x• Fee Rec: j00`Q_ <br /> o Check#: 9-tO3 <br /> m <br /> z <br /> z <br /> Q / Wi v , l—J J,Date of staff site visit: g'l2-8 L? 3 Initial ,of site visit staff: tr <br /> c �, <br /> lill El <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3I/I2-_3 > m corri <br /> 1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y a Q, Gin <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m N c. <br /> w <br /> Page l of 5litil <br /> Burnett County,WI Land Use Application—Rev 12/2022 v — )J <br /> a <br /> 3 <br />