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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> cn N <br /> Applicant Complete All Sections Below This Line 0. o <br /> w <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 '. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a t ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 P. t\11V `; <br /> Filling/Grading $150 Boathouse $500 `I <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $10074.• <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. la <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. F. "" <br /> z <br /> 0 1 <br /> Property Owner's Name: 42 reo Y1 S e-c-Pe!'1 *c <br /> Property Owner's Mailing Address: , g/.2- 7 1,..an e 'Noe Da L rn/ Gf/' `c#g3e I <br /> '/ City State Zip ° <br /> Property Site Address: e2 'J`17 ,A/l -E Ave o y <br /> Contact's Telephone Number: 7/ S 7 3 3 0 41 S g' a <br /> t7 <br /> Contact's Email: Q S ZL P-c-V-Z"' h t) C C'r►- .,Gi ..j�'e 1. h eZ to <br /> **If staff has a question about this application,you will be contacted via mail. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and °Q <br /> @BurnettCountyWI.gov oz <br /> d <br /> Legal Description of Property: 5 /$4 �f + 5 Va. 'V WS t _• <br /> 11 , I 0 <br /> Section#: 6 I Town#: `l U N Range#: I C, W Town of: GG,k IGeti <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I 3"( I al <br /> L <br /> o <br /> --r—- ) <br /> Proposed Use of Structure/Addition: r •f a <br /> Anticipated Start Date: �f (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t. 'll S <br /> Building Contractor: Sewer Installer: 0 � '''1") <br /> pi <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �4- all Sef cLS (54•1e5 tS + 4 5,'k v,s,f) F <br /> t2v4( <br /> Ma- c/ ilov�art f146,11r.:1)0. 4 <br /> ,.(_ I' f � <br /> f lY`u,n o4 G In/ 1 U 4 4 /4 s i' Fee Rec$I50 <br /> I o Check#:6307 <br /> m <br /> z <br /> nl <br /> lDate of staff site visit:5/2)23 Initials f site vis't staff: hr; < r- <br /> ri <br /> m m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:-'!3I -13 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z N MI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT oo <br /> w C <br /> Page l of 5 < cp INL <br /> Burnett County, WI Land Use Application—Rev 3/2023 d r. �L J <br /> a <br /> i <br />