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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> y N <br /> Applicant Complete All Sections Below This Line 0 to <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) +` C7 <br /> Dwelling/Principal Structure $300 Yj Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -. 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 aa <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 mo <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> II <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) $100 a. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. e <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 " `• <br /> z <br /> p <br /> Property Owner's Name:4/Tr- G0 Ai(:;, l/'-- i <br /> / �°o' <br /> Property Owner's Mailing Address: //'qs/ (mod od.kbt.G ST /�GG GL e& Nit/ s yy . <br /> �1S City // State Zip E <br /> Property Site Address: l/Z 7 11/0 /a�'., a G rti, SI,ore Az ife � LdL c N <br /> a <br /> Contact's Telephone Number: [/(2— SOS 73 Sb a <br /> J <br /> Contact's Email: t s /)/)/On• (P/?03 6/7 Alt? • toa� <br /> **If staff has a question ab application, u will be contac a via emaill. Make sure your email address is N '0 <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and . "Q <br /> @BumettCountyWI.gov d <br /> 1— <br /> Legal Description of Property: e T / C S4t ! 90 V 2 7 P n 5. <br /> Section#: d 7 Town#: 3 8 N Range#: /8 W Town of: WO 00 4,J e <br /> cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): 3 51 1 / a 6 <br /> ! <br /> Proposed Use of Structure/A dition: ictl—flton !—It✓f A l /) I (o t �1-) <br /> Anticipated Start Date: L —/ (Home/Cabin, Commercial Business;Bedroom;Deck;etc.) 1 <br /> Building Contractor: 5'Q1'1--- Sewer Installer: A./9- r i ~L <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0mee — ali 5ethG °0 <br /> 1(U +- +v l/)cire45t ,bratrr roorn$tibvi r <br /> -la be SertliceCf ail reric 40t L'ei <br /> e 4FeeRec:eva.lu�ll.00 cbi- Cheek#:(rn <br /> z <br /> 0 <br /> 1I n? u <br /> Date of staff site visit: 1'/'T /CJ I iti Is of sit visit staff: rl r < D,- <br /> n n, <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: II/X/2-3 m Qff <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Z cp ( N ffi <br /> z vo tv <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1of5 < a c. <br /> Burnett County,WI Land Use Application-Rev 12/2022 0 <br />