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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> N <br /> Applicant Complete All Sections Below This Line w <br /> CD 1 <br /> Permit Types and Fees:(Please,check appropriate boxes) 11c t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 k.t O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 6 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 ;A <br /> Filling/Grading $150 Boathouse $500 N <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ 6" <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. 0 <br /> b <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 /> p <br /> Property Owner's Name: T H C WIA S E L\I N 1J b ''BUit_e tC o 11 <br /> A�1 D 5 i rat E (z_ ZO c u,I 54,29_3 `° <br /> Property Owner's Mailing Address: n <br /> S e A- 14.0� City State Zip ° <br /> Property Site Address: OPA 22 '� o N • <br /> ' - <br /> Contact's Telephone Number: Z �Q,� b V�, 115-6 bb'Z�j 5 ~ <br /> ("Q d (' <br /> Contact's Email: (-CA Cho fee` L r S ohs W 1 ik1 1 • C o CD**If staff has a question about this application,you will be contacted via sail. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and E og <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: r'UT I C SPA ? ` 0 0 <br /> rA <br /> 6. k)4). <br /> Section#: Oh\ Town#:38 to N Range#: I S W Town of: L A f v L- I-- (Try, r �, <br /> *Attach additional page if needed for lengthy description OR attachta a copy of the deed OR attach tax system property page.* G :c.: <br /> Tax ID#(1-5 digit number; found on tax statement): 1 3 <br /> Proposed Use of Structure/Addition; 5 1 o ft..�5 G W <br /> Anticipated Start Date: �-\� t\ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Q <br /> Building Contractor: le:Se-c C & (_O 1 -I h L Sewer Installer: N Okic (e <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> of Av, Ce I4ce- ex;S4)' �1 <br /> (heed' 4N 0,,,,, 7%.- .,, , ,e41--s- , <br /> c) 4- 4r L o k4 , <br /> x Fee Rec:1,,2j <br /> 5IGV•le q m v Check#: /4Oj61.7/ <br /> m <br /> z <br /> 0 <br /> Date of staff site visit: l�D l/3 In'ti Is of site sit staff: He < �J� <br /> APPROVED BY LAND SERVICES OFFICIAL: L T DATE: 11/ 64-3 cn a VEI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF CDCn cri <br /> W C51 <br /> o <br /> Oil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 o 0 < <br /> Page 1 of 5 a'` cc <br /> hill <br /> Burnett County,WI Land Use Application—Rev 12/2022 v <br /> z <br />