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LAND USE PERMIT APPLICATION- Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line N <br /> cn <br /> CD <br /> Permit Types and Fees(Please,check appropriate boxes) i <br /> d Lri <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Rl <br /> n EDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $25p ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o ul <br /> Filling/Grading $150 Boathouse $500 <br /> w <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a Z II, <br /> z <br /> i <br /> Property Owner's Name: WA E —±- STP1-1/4N I E L P£TFi?S o A) <br /> Property Owner's Mailing Address39.1.W TA C-Ks oN /ti II)E. oir/9/tirsaat,, I,J1 S 4g/D I. ` <br /> City State Zip E <br /> Property Site Address:-/0 F)/I 19A) Fr ?6 o <br /> Contact's Telephone Number: 7/,S -q dl y31�-' 0 B'S6 a <br /> 0 <br /> Contact's Email: w e P 19 82e 9 rtl q i i d m i <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and 00 <br /> @BurnettCountyWl.gov <br /> C <br /> � I ' . <br /> Legal Description of Property: /a IVr Are <br /> p. <br /> Section#: 3,1 Town#: 39 N Range#: / W Town of: (,.'E-T //?/gr..0 G4-A)b <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* , . c K <br /> Tax ID#(1-5 digit number;found on tax statement): 497.S'70 o <br /> a <br /> Proposed Use of Structure/Addition: STOR 19 67C `-.\ <br /> Anticipated Start Date: 5//i2 Oa.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _il <br /> Building Contractor: St-LC Sewer Installer: t! <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> PoTHIS PERMIT IS S BJE T TO ALL CONDITIONS LISTED BELOW: <br /> ine�-1-- w U Se ,,c kStelitisf- he 4D 41- - (o,.1 vve-1k�) 00 <br /> 0 hof Trot'" Jev741 A4 :k ' <br /> Fee Rec:ui <br /> __'s <br /> ?ilo Check#:i <br /> z <br /> 0 <br /> 31�►1�3 � �� < m �--��� <br /> Date of staff site visit: nitia of to isit staff:�,,�///� rn <br /> n a End <br /> APPROVED BY LAND SERVICES OFFICIAL: �C�J! DATE: 3/2423 m W n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a; CDc o m ERN <br /> y <br /> o NJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m .. e <br /> Pagelof5 < w �U <br /> Burnett County,WI Land Use Application -Rev 12/2022 0 �L )) <br /> a <br />