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DocuSign Envelope ID:77ACCA61-D821-4040-8255-A5C58DOAF83F <br /> LAND USE PERMIT APPLICATION —Burnett County, WI 5 3 c <br /> -o <br /> E. <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,.0 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> XSolar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 t. k <br /> ib <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `e. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 19 <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2 z \ <br /> o <br /> Property Owner's Name: No6srtr(\ °i cik#c i (i t K, ( l1X.t7' c-ckvY\I i td L t' T I 11 <br /> 1 <br /> Property Owner's Mailing Address: Xa C+ 1 \c1 Web mil- l,,°1 ' L` 2 '-i. y. 1el 11 <br /> City State Zip K Ili <br /> Site Address: =)' )Vl (Tt� C�d l P v) ,hr- ' ( `„'' 1 6,4�i c I.3 a <br /> Contact's Telephone Number: _1 ) q 3 L( - '3UCAS- e <br /> 1 <br /> Contact's Email: t. C tYv, +f)G C f `,C'AGY 3 v ; cti = (>5 <br /> **lf staff has a question about this application,you will be contacted via email. Make sure your email address is N `C <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: Oak lct' 4X1t f t'°i No 1 LC) CI 4 e-}G. "S <br /> Section#: C) Town#: '-I G N Range#: 1`% W Town of: `~j('i -i--1— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F kS <br /> _ <br /> Tax ID#(1-5 digit number;found on tax statement): ICI �!O 9J C' °. <br /> -4 <br /> Proposed Use of Structure/Addition:1c i 0 k 0,6\ 5 Ct\CO 1)(..11 vC\`.� t�!\C!c 'C k.(1,r,i t( -_\F_c\t <br /> Anticipated Start Date: (Flome.'Cabin;Commercial Business;Bedroom;Deck:ere,) - �C <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS UB ECT TO ALL CONDITIONS LISTED BELOW: e <br /> rn t;e,� a.�l se5+ ' -C <br /> . FA«e.I n eees Ce/ 1;ec� scsrvej ill 01 u lMOl.e lags <br /> _L f hh �^ /-,teo <br /> (k+ 1L co i , ?-0 r _ Fee Rec: G50 <br /> (/ V � Check#: ((,37 <br /> n <br /> z <br /> 0 <br /> 7 ✓ x <br /> Date of staff site visit: /pZ / I�� Initial o•f s' sit staff: ..,„ <br /> APPROVED BY LAND SERVICES OFFICIAL: i •/ DATE:11791r2 / )/23 �—f=—� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° Q ntrill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT p 2 N '�^' <br /> Page l of < o0 N r� <br /> Burnett County,WI Land Use Application-Rev 12/2022 e 2, < rw <br /> 3 w Rd <br /> y CD Jut) <br /> S <br />