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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line = w <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 OQ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> . <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° ),) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c W <br /> a <br /> Filling/Grading $150 Boathouse $500 v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 i <br /> . <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. bw ( <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. S Z �' <br /> 0 1. <br /> Property Owner's Name: 1 hc)✓r.c.S C ( ,nton / T0.tlora. ( AA y =' b <br /> 0 <br /> L} I �g �U� N2 Mf�S, 11�tssyz2 `. <br /> Property Owner's Mailing Address: X e i aw <br /> Qq O jj,_ i y 1 tty State Zip ° 1 <br /> Property Site Address: V i l ��.��121�) LQ T�e �C orb v t•y W I 5 530 -` o y e� <br /> Contact's Telephone Number: Co I Z - -7 t{1 - <br /> 'ia .-5 1 E. r <br /> Contact's Email: t In t I-t I Zg 0 U"t' 10 t t. ' C Q M o P' <br /> b. <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro lip <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and z °0 '� <br /> @BurnettCountyWI.gov 5 ' Li Li 73 Vol ?4 P? 3 c 3 - udd- 4 I sae Kj <br /> Legal Description of Property: (ck 4 g ?i O 0 1-d 3 2 -2 - 4I -i t-3 3 y ` <br /> .; W <br /> Section#: 3 `5 Town#: 4 1 N Range#: Ho W Town of: g Q r in e t i' (c3 to nt 1 S W'SS a, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f r'-:3Tax ID#(1-5 digit number;found on tax statement): 3 3 J S % _ I g Fi <br /> Proposed Use of Structure/Addition: 4 d X 4g0 Pat e be en -� WAnticipated Start Date: IY1 ca.v G In a.0.3 ii(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: J 0✓tit`1 tv 4 to I i c ►n9 S Sewer Installer: NU n.n S CA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1 0h e e-- - a(I .5 e-��►ctfik-S , <br /> \kA- -6( kite'L" )1 6•b•-61-4)'"1 <br /> x Fee Rec: it9 0� <br /> d Check#: .20 33 <br /> m <br /> > <br /> a <br /> 0 <br /> cm <br /> Date of staff site visit:3 l?7/a3 Initi s of site 'sit staff: h < " J <br /> „ , —. � <br /> APPROVED BY LAND SERVICES OFFICIAL: 3 a g /73 DATE: °1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <W t 0 <br /> z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> o o w _ <br /> Pagelof5 < wK N <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 3 `• <br /> -I . l l J <br />