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LAND USE PERMIT APPLICATION — Burnett County, WI a `° b <br /> y g <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees(Please,check appropriate boxes) CI. <br /> d <br /> y (� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cp <br /> r— <br /> Commercial/Industrial Structure 1 $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.)\ Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> �� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G7° .sJ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o W <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <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. L <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. II <br /> �. <br /> z <br /> /�A a <br /> Property Owner's Name: e 1ev1, 1 v,GArtro,A,0 3 JEAN E lE M E Oi NO i o ! lW <br /> ..z tProperty Owner's Mailing Address: C (95- D C _? COD L tJ p c-. '1 k' 95 (9 n w <br /> City State Zip IN <br /> Property Site Address: T n , i a 1 .48 < <br /> O In <br /> Contact's Telephone Number: '7 C 3-- '7'7 3:?d 1 N <br /> O d <br /> Contact's Email: F2 OS E PE D P-A NO c ail-LOOK-CO-4 % <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,0 6" <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0, an N <br /> @BurnettCountyWLgov ..p 3c q50 cmJ N <br /> Legal Description of Property: NE N W Sag'`f 39 AI 21 rnW - Lp f 1 C S M If aQ P?9 (. O <br /> d <br /> Section#: Town#: N Range#: W Town of: MlE t,NQN <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* w <br /> Tax ID#(1-5 digit number;found on tax statement): I,A 1 '- S d <br /> Proposed Use of Structure/Addition: ST-UI2P. ,E ro(N) N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C <br /> Building Contractor: k-P4ZDWADE 1- 4l k BLLQ- Sewer Installer: N C tom% <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -Imo.+ ct,U Sk,-0000k-S 6' 1 <br /> -N o 5-h�uc,-hoc txl --1-I�.(S Par(C I I S Kr m i-(€-d ANc" h AIYI L V\ <br /> 1CL7 1-Foc ta - x Fee Rec: 30(1'Di <br /> ,� <br /> - 1161GlreS •(S ►fie l lat.( I2''1 I ZD2.3 o Check#:c� DL) <br /> m <br /> z <br /> v <br /> cn <br /> rn <br /> Date of staff site visit: 14/it /2,02.3 Initials of sit visit staff: < <br /> n.APPROVED BY LAND SERVICES OFFICIA � i _______DATE: q /21-f/2023rn r "", <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF .. cr,c n 0 <br /> z 5.3 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y a �t <br /> a vo 0 <br /> m O <br /> Pagelof5 < m� N„ <br /> Burnett County,WI Land Use Application—Rev 12/2022 v ``' bill <br /> . <br />