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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a <br /> • <br /> Applicant Complete All Sections Below This Line c N <br /> Permit Types and Fees:(Please,check appropriate boxes) 0. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> NK <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G <br /> Driveways/&Campground Structures �J". ii5 WI State Statute 59.692(1v)Structures $350 • <br /> r 5" <br /> 0 <br /> Filling/Grading $150 Boathouse $500 + <br /> to <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aqui red after construction has begun)may cost up to three times the normal fee. -k._ <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. 5 <br /> `Items not listed above will be treated as accessory structures,such as.oeraolas,landscaping,etc. i I p <br /> Property Owner's Name: ry G I n Q--f e.c 1 r? % 5 L r o in a <br /> v g- <br /> 1 .0 <br /> Er. ri <br /> Property Owner's Mailing Address: l 0(p 3 9 S i [ V c. ' 1.....,14 1�0 . ° <br /> City State Zip <br /> Property Site Address: ( O 51 l V CAI L„14e )2.0 f m f12 v v e� GS T.- S $4/0 ° F <br /> Contact's Telephone Number: (o ( 2 ^ .30&, — t S 3 C( U N "e <br /> FD <br /> .. <br /> Contact's Email: KVN STIR c M 9 ti rki.Li C.,.O 4 o <br /> Legal Description of Property: ( o1r a, C 5 M Y 21 i2,,o, 3191 0) ( rk v Lo'f ZD c o <br /> d O <br /> Section#: 3(P Town#: S$N N Range#: i to W Town of: \/'.)e o I e - <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> LID <br /> Tax ID#(1-5 digit number; found on tax statement): ^^�.l L-I i ( -3 <br /> P _ +J e�k / 7 Ae r `N <br /> Proposed Use of Structure/Addition: "�'L � d <br /> Anticipated Start Date:L'p k,[ Seer Z p L' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> Building Contractor:O PrG(a'S 13p,o5 (f,J pis-re,'cri 0 NI Sewer Installer: S.N !„. --D <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> ** pp.. r_. �.,_ flu* ;determine f"> vvr, !:is=needed themprior to I�**The 71"� ta.cii:: sa:cw.r w ..vl:.ssits csses. � IEa;ivt"t� . __r...:'t �C..:e.".0 � j <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes,manufactured <br /> home additions, and bunkhouses.** 0.4? <br /> ' Frr-Pi-k-- Ova c Jbet (w a9 OdJ('r�'lk��' i�e�u s �Yl r a�p`l1 p <br /> AY- <br /> Fee Rec: O <br /> 1,4 0 !1/Zc2.3 g, Check#: .2Ol 8" <br /> Date of staff site visit: 0 0 ZoZ? Initials of site visit staff: kT m <br /> a <br /> I U o J <br /> APPROVED BY LAND SERVICES OFFICIAL: ijI� ATE: //Z(Q 70Z3 m . <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m T T n t0 <br /> Z C� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o cfi2 0 EN <br /> Page l of 5 m `�`' <br /> ITH <br /> Burnett County, WI Land Use Application—Rev 05/2022 < _ Lk...... <br /> �m J <br /> u <br /> a <br /> x <br />