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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees(Please,check appropriate boxes) °' <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 e� O <br /> 4 Accessory Structure(Garage,Shed,etc.) $ >( Addition/Alteration to Accessory Structure_ 3004 -' 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 J d <br /> eck tairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° A <br /> rivewa s/&Campground Structures o <br /> y pg $125 WI State Statute 59.692(iv)Structures $350 W <br /> Filling/Grading $150 Boathouse $500 .» N <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> k <br /> z <br /> Property Owner's Name: ne�. r♦ .�<n C-, (,.:*� 0 3 <br /> � i a <br /> Property Owner's Mailing Address: Z 8`125 0 A s a c4ss t_�- 1Z C'a \_ y `~'`5:4e3c, v. <br /> 1 City �.r state Zip k "' <br /> Property Site Address: 'S c -'-'"c.- ek,4 a- -...2e_- <br /> N <br /> . z <br /> Contact's Telephone Number: ta5l_ �-31- Li Siv—T a <br /> t7 <br /> DO <br /> Contact's Email: Pn��.1 5 v Y-c a 1-(vr_--1- c�v cs.v L , C-c _ " <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,ro I <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °a °Q <br /> @BumettCountyWl.gov <br /> ' d <br /> `t <br /> D <br /> Legal Description of Property:` C L. ��. Lo-� s. <br /> Section#: I 3 Town#: q 0 N Range#: 1 7 W Town of: Uri,'Coil I <br /> cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ,� _ o <br /> ma Wa <br /> p2 4Tax ID#(1-5 digit number;found on tax statement): 7(/'�'y) r7 <br /> Proposed Use of Structure/Addition: DeCK 4" 6c4.1c9 e Q(t dH4).0 1 ' <br /> Anticipated Start Date: DA44 A4.4O/.A (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: (J Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1 i 5f v4 ee$- a 11 54b4cIS 'J <br /> Odd hitOt ..l L L b,:-r..-h'v 7/,I ,M <br /> ØFOQ neck -I� ,�bc vAlw'11 75 OftW�'" Fee Red: "Ir}^� <br /> !� 6/� > „�/ e O {(— �( 1�0��� $4�t.SoA P^'a 3 o Check#: 101(&F <br /> � 5 �1 m <br /> z <br /> v <br /> 'J IIt EtDate of staff site visit: "[ '1 G t I)3 Initial of s' e isit staff: H1' <br /> APPROVED BY LAND SERVICES OFFICIAL: L� DATE:`1/ W3 -' p >,,... <br /> "' ...cQ <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o (18 <br /> r. - . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m• <br /> Pagelof5 J <br /> Burnett County, WI Land Use Application-Rev 12/2022 v i —:t r <br />