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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line s c w <br /> PP p CD , <br /> Permit Types and Fees:(P/ease,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> n Accessory Structure(Garage,Shed,etc.0 $J' Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ! , <br /> G� d <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F <br /> Filling/Grading $150 Boathouse $500 d <br /> u, <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 /> v <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' I <br /> Z <br /> Property Owner's Name:_R___°/'/4(=l'J ttJ / $S I o — <br /> _ o <br /> Property Owner's Mailing Address: / k e-e4✓ TeOQ{L- �� S �- "� C' VI <br /> Ci y State Zip ° E 0 v' <br /> Property Site Address: 9 7? &" ee,t, 7‘. .i4 r L GL/&., s T2 �1 7 o/ ..- <br /> / <br /> J • C <br /> Contact's Telephone Number: 667 SS'— ,--59 CD <br /> N <br /> Contact's Email: /0, 'k/eic5 c6'/ , O(, Tz 0e9, , Co ay/ C% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °Q f&-cs o L es T.S 4. 1� F.; <br /> 4/ f 3. <br /> @BurnettCountyWl.gov d <br /> ro o DC) <br /> Legal Description of Property: (,e/ <br /> Section#: 2-6 Town#: Pio N Range#: (cW Town of: >rc/e✓S 0 iz/ .7 \ c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* M NI o 5 <br /> _, �. f _ <br /> Tax ID#(1-5 digit number; found on tax statement): cj ?© ) "1 d <br /> Proposed Use of Structure/Addi ion: ,g l o i wa0 o re f, ,Cf/o_e /,,A-C f) <br /> Anticipated Start Date:f OQ 9 (Home/Cabin;Commercial Business;Bedrooms,,•Deck;etc.) a. <br /> Building Contractor: 11 -� Sewer Installer: O 3 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> - Nli.ek- oU sk.-1 k-s 01 <br /> No+ - V\kkmrLYk hab c-{t ay-1 <br /> -Pautn c . c , ►s y\M- ca.�,1,0 .d. U; 4c n 50-C-k- 04 +kA.f DrcAA K z FeeRec: 300T <br /> hi°J3 \cIr,.Uru4ty- fsikpl K- CO AD INA . tvvuS'E' ‘0,_ (2 ced btha. 4° Q r- l(10,,1 s m Check#:glEflp_ <br /> 1 veye-la an 9( (5104 $1 l I2023.rCD►NI-a(k Sht(dC n d Sioba ;s-t E <br /> z <br /> /� E'fl 11 (�pprk c. <br /> o <br /> Date of staff site visit: 3�2$i loll Init'als of sit visit staff: I < l II��,,J��,,'' <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �I5/ZDZ �j 9 m a <br /> uuu <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o c <br /> z co <br /> 1=, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2= w <br /> Page l of 5 <br /> e I(ltll <br /> Burnett County,WI Land Use Application—Rev 12/2022 v — , i <br /> a <br /> 3 <br />