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LAND USE PERMIT APPLICATION — Burnett County, WI c `° <br /> Applicant Complete All Sections Below This Line S. w <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <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 \ p <br /> Accessory Structure(Garage,Shed,etc.)&361>Jtta Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G° <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> D <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. ' I- <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' 0 <br /> z <br /> 0Nw' <br /> (e <br /> Property Owner's Name: Re) It.i' Ce (p 1 e tt to P LA (•4-a IJ G is o ( <br /> a. vv <br /> Property Owner's Mailing Address: I ?oZ UFi c lL A- Q 1City State Zip = Q grl <br /> Property Site Address: 7,1,) .Der k L-1415 e Rc0• SpoT,/t%eie 11.Z 54(£�O) o <br /> Contact's Telephone Number: (p S(- D.7�- 6 ( 33 d <br /> • <br /> Contact's Email: oQ r b S 3 k co`nj to 5 vt-, ili c' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro < <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °Q c,J <br /> @BurnettCountyWI.gov a 0 <br /> r — <br /> Legal Description of Property:Th 6 P2T (,0 v 1-©-�- 3 S�: T,61 4:4gL/`1a8 a. .4 <br /> o <br /> Section#: Town#: N Range#: W Town of: �t?i,c9k u, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* — 0 AD <br /> = C <br /> Tax ID#(1-5 digit number;found on tax statement): /5gto <br /> y <br /> Proposed Use of Structure/Addition: -}'Q Ie BA-R t LS-3-z i2Q z r er) �, c31 <br /> Anticipated Start Date: hONC. (Home/Cabin;Commercial Business,Bedroom;Deck;etc.) '� ..9 <br /> Building Contractor: t )A I TFFe if S Sewer Installer: �C <br /> z W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - N .4 aU St-NooJ S <br /> - Lou- c&c. c)Aa t n a \ S_e 9* -ka.rt L. 1,i ci. c - cam- 4:1 - <br /> -O ul-6,cor 1 Lurnb i ruD CA teki G-s 4 t °vt.`1. °r CC"eLt-e6 41:3' " x Fee Rec:3Cf9 <br /> c <br /> Check#:9' <br /> Svp-i-i c SkiS-EeJrn bl 101 t 12023 0 <br /> z <br /> [�/�D 2 0 <br /> CID Date of staff site visit: / 02-3 Initials of site visit staff: < II II ff � <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: 5/4 ZDZ3 Di) ro <br /> UPON APP <br /> ROVAL: APPLICANT MUST POST COPY OF o <W MI0 <br /> •- 2 c,.D IV Innl' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ,. o 0 v �J <br /> 1V <br /> Page1of5 < °, w - ' <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 <br /> i <br />