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LAND USE PERMIT APPLICATION — Burnett County WI a <br /> Applicant Complete All Sections Below This Line ° 1 a # <br /> Permit Types and Fees(Please,check appropriate boxes) d Z <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structural' '$300 Addition/Alteration to Commercial/Industrial Structure $200 4.1 <br /> Accessory Structure(Garage,Shed,etc.) 'MO Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 -� <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> 1 Filling/Grading $150 Boathouse $500 <br /> c4 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 _ Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> ;v <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> o ‘---, <br /> Property Owner's Name: IC1{Ar-A 7- 1.--(01)1-{6 — o lb <br /> 0 <br /> I <br /> Property Owner's Mailing Address: ( () aPD/� • 6 3IQiMI�rd� N 53' / n n p <br /> //��q►p,U G f ,eD DP1.I6uCr �,City State Zip cn <br /> Property Site Address: o� ( E. ( )�E ZA-kr 5 c18 30 o c <br /> Contact's Telephone Number: l - L/ , ,a3- lb. ca. <br /> d <br /> w <br /> Contact's Email: fr'•(Cld• LINt)bkoufrt G 6/4 cztEK' •cc9M = <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 = °G <br /> @BurnettCountyWI.gov CFO <br /> 114A,T 'Mel" pF >v I la. 6V./i_YoN& NL Y e <br /> Legal Description of Property: a W/LY OF LCAI& CAKE (f.D,1/41 <br /> Section#: 0 5. Town#: LID N Range#: I q W Town of: .CoT.1— <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7 Q f <br /> ( o <br /> Tax ID#(1-5 digit number;found on tax statement): I-}1.t k lT <br /> -3 <br /> Proposed Use of Structure/Addition: 61'01E-AcLE s1460 <br /> Anticipated Start Date:NlAitt f{ O.'2> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) = <br /> Building Contractor: N/A• Sewer Installer: AI/A. <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: II_ <br /> 11 sego <br /> Dvo\--,Cy �,µ�ta/ �b�h o a ✓vfwS� ✓>�. 4 a - --L, <br /> Tpoiii, - Foy ow- be- 13111.23 <br /> i' Fee Rec: YC'- <br /> (Ca er r•�;n e <br /> r . (�o 4o�' Jt5 a.se- �C- 61 a✓vGry:y o Check#: lyals� <br /> Sa,i 5,,.re- c <br /> Date of staff site visit:]/13/a3 itials site vi ' staff: fi� < G� <br /> N r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 1"I ` 3 rr rFill <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z $ _= 0 <br /> VEI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m 0 l.o N <br /> Page l of 5 - w <br /> mi <br /> Burnett County,WI Land Use Application— Rev 12/2022 0 <br /> •T3 3 <br />