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LAND USE PERMIT APPLICATION — Burnett County, WI 0 <br /> . a <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees'Please,check appropriate boxes) ° <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c <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 3e0 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° k P <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 . VI <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R. <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. a pi, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g" . <br /> z <br /> 11 <br /> Property Owner's Name:_ /�f P 1L k 1�l`C L+L.w, IC±6-t/a?' ):11-o ("1 <br /> IVAPLC L2tc r8- <br /> Property Owner's Mailing Address: 4 OiAl'L 1 JU J tr t: LA. A-' ivi,v �S Ii l TT In 0 <br /> City State Zip ° ..1 <br /> Property Site Address: 2-&I S b ki1/4; l l C.ct,,u; 52-1 U ri 13 .2-y / 4� , C e,-i ,a o Fc 24 <br /> • <br /> a <br /> Contact's Telephone Number: 76 2 - 421 z -- `ii 6 C. n. ` <br /> n d C <br /> Contact's Email: M c:J?((o I L M e` it-oT r'H AI(.. t cevt s p`. <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N S <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and . tl0 N <br /> @BumettCountyWl.gov o,:, <br /> Legal Description of Property: R t U A. O 4 t 5 L 1 iJ -r IN 0i,' L.e S / ' a 3. 8 ? <br /> Section#: 0-1 Town#:,. yt N Range#: I(p W Town of: 0,}4C.e.4 d <br /> 6' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0 <br /> Tax ID#(1-5 digit number; found on tax statement): I H 3 b c --,IO d <br /> .4 Q <br /> Proposed Use of Structure/Addition: S rO12 t 6 r <br /> Anticipated Start Date: Co M r t N' (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> Building Contractor: "Ik' Sewer Installer: f !h <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r <br /> 10A all %-ilateks <br /> No+ - 1(1,ckb i- - 1 O{ <br /> Fee Rec: 3( <br /> -Cock aril alain n eedkd Do stoic -f an k lid by 311 /223 m Check#: <br /> z <br /> v <br /> v �� ) m <br /> Date of staff site visit: 1 /27/ ol3' Initials of site visit staff: I <_ =_ � <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 511 /202-3 y <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z W W t 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 2.o o = <br /> Page 1of5 < 0`< w <br /> Burnett County, WI Land Use Application—Rev 12/2022 0 1 Lk...... Vl' <br /> J <br />