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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line °. i w <br /> Permit Types and Fees(Please,check appropriate boxes) l a <br /> d V' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 W 0 <br /> fAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 E <br /> Filling/Grading $150 Boathouse $500 cn <br /> ( <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. i <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. `D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> Property Owner's Name: C,&cc L 4 V ,c o rr k. <br /> °o <br /> 0. <br /> 1 c <br /> Property Owner's Mailing Address: Cot 5� CoJ AVT., 'RO C. W z' *e( 4. S i 3 <br /> _ _ 1 City State Zip <br /> Property Site Address: 6, I S 5 (f7,,n1,,, R'D C w�, E-tr [#Z o ti <br /> Contact's Telephone Number: So 9 " S S O-- ' 25 r a <br /> C <br /> d <br /> Contact's Email: kii:m b.):1c)ir't{ 0 VAt1 00• Ca" Po <br /> **If staff has a question about this applkation,you will 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 0 °Q <br /> 5' <br /> @BurnettCountyWI.gov °Q <br /> Legal Description of Property: ( / SW �ix liti 17 b CV`e 5 R. <br /> Section#: 1 3 Town#: LI 0 N Range#: 1 b W Town of: 0: It." L 6 En <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* _ E H <br /> Tax ID#(1-5 digit number; found on tax statement): �'"i HCI� H <br /> '):10 d <br /> Proposed Use of Structure/Addition: 9 ofcotNL + - . <br /> Anticipated Start Date: Li- / - d 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) k':, ..� <br /> Building Contractor: Se/ic Sewer Installer: 1+ <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x 14 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Me-e k et l( 5 e-{-b a c , . ix, pak6chit' POST.- n,e4 a k.•Lat r <br /> rrl at✓1 !lR D. 4)di 05e f er.r44-• <br /> �-+ �,��,�d once cons �v4 ;s ��pick- <br /> ',) _ <br /> Pal I Mind c7). <br /> Fee Rec: �L <br /> A1� A`�f 5 lkre5 l_, i�P 5 4' ��, T�titer m Check#: /9jft <br /> or I)eI/h;-1-s reaav ec� w e 4 o� Co 5'�'a"` <br /> f z <br /> v <br /> Date of staff site visit: 3i?) 2-3 i is of nt staff: < r J <br /> CA 7 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: /2 / 3 <br /> (DC 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y, 7 M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT s g N <br /> Page 1 of 5 < 3 w <br /> Ina <br /> Burnett County, WI Land Use Application—Rev 12/2022 v <br /> a �L <br /> K <br />