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LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line ° CD a `;J <br /> Permit Types and Fees:(Please,check appropriate boxes) c-- <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 o Q <br /> Commercial/Industrial Structur $300 Addition/Alteration to Commercial/Industrial Structure $200 '�p <br /> Z. <br /> Accessory Structure(Garage,Shed,etc.) y1 ;0 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n i. <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r°r. <br /> Filling/Grading $150 Boathouse $500 cn i <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> c. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> $: <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. l <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z <br /> o <br /> Property Owner's Name: /gar,'/7 ,9a!ii , o - , <br /> I. f ,-�✓�.., /t�.Ai 5Tc 3. �- -- <br /> Property Owner's Mailing Address: D7C7$ t r i c) <br /> AlCity State Zip vi <br /> Property Site Address:6 73 9 Lse e r Trek c* r{i^ �1- �y,7 A N <br /> Contact's Telephone Number: 6'0) - a D7 — _9d / n <br /> Contact's Email: a a rC7e'' C A 441 I e C.0 0-, <br /> CD <br /> **If staff has a question about this applation,yoill be contacted via email. Make sure your email address is N •o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> 5' <br /> @BumettCountyWI.gov °O <br /> 0. <br /> Legal Description of Property: 5</ c' �/ J <br /> e` E. <br /> Section#: 0 3 Town#: 3 N Range#: 1 6 W Town of: Si f t✓, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach 7- <br /> tax system properly page.* F <br /> [ <br /> Tax ID#(1-5 digit number; found on tax statement): / 9 6 7 V 1-- 1 9 6 � <br /> 1 <br /> Proposed Use of Structure/Addition: ,:v f a 5 e '� W 0 <br /> Anticipated Start Date: N if (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) — .. <br /> Sewer Installer: � r <br /> Building Contractor: N `1- <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ti. <br /> 0 Nei- 70 k e_ t.(S a .6 Y` A u met N A !d J T':'74©A- , <br /> DTh is /' fuOo SP�Ana pa�S, -'lt e_ o Sou/ icv.� 00 <br /> bY'U CAA PV-- N 7L mti€71- U), S/ s Qa y Fee Rec: <br /> v Check#: /O a <br /> S�rtAc. re_s A 6e 11/4I q cow►p/,a071-- /ocrr>1io/h Oi m <br /> tile_ Pares 6e cow) tat I W1`7� cc GSM �6y 1°/l/2 �,3, o <br /> Date of staff site visit: �3 Initials of site via' taff: A7-- <br /> r,' 'ua. D �n <br /> n, m , U (/ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 0-9/Z40 2.-3 2.3 = <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o 2 <br /> I N IN PLAIN SIGHT r <br /> SIGNET) PERMIT APPLICAT OnCr0 <br /> Pagelof5 < �._ JJ <br /> Burnett County,WI Land Use Application-Rev 12/2022 v <br /> -3 <br /> a <br /> x <br />