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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> cn N <br /> Applicant Complete All Sections Below This Line a. CD I <br /> • (14 <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 V• <br /> Dwelling/Principal Structure $300 > Addition/Alteration to Dwelling/Principal Structure $200 " Rj <br /> Commercial/Industrial Structure $300 / Addition/Alteration to Commercial/Industrial Structure $200 p <br /> � g <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 UJ N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g • ('"" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < lJ <br /> G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 cn <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <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. 0 <br /> 4. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 1 A to tt�r1/4 e f4 t-- d‘S E A .11 <br /> ilb <br /> 0 nn <br /> Property Owner's Mailing Address: Z4V 9 9.S e_,j rlvw fie 11 L a,n e :t ed, c6"Z SYV-1-,d. n <br /> City State Zip ° ' <br /> Property Site Address: 4viA L o ' <br /> . c <br /> CD <br /> Contact's Telephone Number: '1 f S z-Z` 3(,;, a.d <br /> Contact's Email: /qu MDi'4-(916 4-646t , C o, <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> @BumettCountyWI.gov °°° — '----N <br /> c <br /> d CA O <br /> Legal Description of Property: L r z. 1 r, -C i- <br /> Section#: Town#: Sai N Range#: [(o W Town of: MP e A o r' V) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* V “ V <br /> Tax ID#(1-5 digit number;found on tax statement): /Z41'�`i <br /> Odd ` ` `� N <br /> Proposed Use of Structure/Addition: . ( -i-i o n ,'�' (- � S •ti W <br /> Anticipated Start Date: /74Ay Z 2 +-L (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .. -L` <br /> V\ <br /> Building Contractor: ,S,zf 4 Sewer Installer: <br /> BELOW THIS LINEFOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> AREA <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -Nox-k- aJil S,e,k10 r S <br /> - ?ex hD,r , 0,,.A.2r ...14 >_ MA.,yy),\ 6c. ,d�m beS i S YID+ ,- X Cetdi, <br /> (I <br /> 12 x Fee Rec: C CYY ' <br /> 2. LN9P- 21 <br /> ✓• Check#:('[�y k- <br /> m <br /> o Date of staff site visit: (i/V9/2,0Z3 Initials of site V it staff:96 < n —/\=MIJ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 6 3 w < " 73 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z g N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> a) Ind <br /> Page l of 5 m R. <br /> Burnett County,WI Land Use Application-Rev 3/2023 v �� <br /> a <br />