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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> N: E N <br /> Applicant Complete All Sections Below This Line 0 w <br /> CD I <br /> a. <br /> rPermit Types and Fees:(P/ease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200co <br /> Commercial/Industrial Structure j` $300 Addition/Alteration to Commercial/Industrial Structure $200 rt.O <br /> 1 Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C�t <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <° II <br /> Driveways/&Campground Structures $125, WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 111 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? f+ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> �� <br /> Property Owner's Name:Titvrhu,S HZb-e.i o I` <br /> Property Owner's Mailing Address: 1a3t4 iI'ol chi PPeWcc, (tills CO 1- 5c{7�f 1. I ti <br /> City State Zip �� E <br /> Property Site Address: 2 55`1ct K(cifbI V i bt rd. 6 Can45 burl <br /> 7t 7,5-?�Zy y 77 c. <br /> Contacts Telephone Number: 5-559- `l i/2 y <br /> C7 <br /> Contact's Emaii:ctipectr2.Q C . hef Heber+Pc,Oe y9 Q 0 ibu;I GL►'h =% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is IN ro <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and R. °Q <br /> @BumettCountyWI.gov <br /> Legal Description of Property: Cab41 5 330 Of Ai 1..30' OF 1--- 1/2- NE A Ini <br /> Section#: 30 Town#:34 A) N Range#: 17 W Town of: Li li c.or, -\--\ vi <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F <br /> Tax ID#(1-5 digit number;found on tax statement): IOci IO p <br /> Proposed Use of Structure/Addition: 3 hed <br /> -3 11-. <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Lkg <br /> Building Contractor: 33I I Sewer Installer: A/M- <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Pz 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 1 /V c d.....4:,/ 116.1) 4fr1 l'I rJt Wo <br /> Fee Rec: )(L,L <br /> o Check#: I i)i <br /> z <br /> 2 0 <br /> J3J <br /> Date of staff site visit:LI/1i 1 I itial of site sit staff: 11� rn t <br /> 4P-1/?-3 <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: , DATE: a M <br /> 2.UPON APPROVAL: APPLICANT MUST POST COPY OF 70'z 5 5 It 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 o — = <br /> Page l of 5 rii m.,< <br /> co <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 s, NU <br />