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r <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o w <br /> Permit Types and Fees:(Please,check appropriate boxes) a C7 <br /> 7\ Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> f <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 " <br /> C)o <br /> V <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> or� <br /> Filling/Grading $150 Boathouse $500 ct <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `$ ,p <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9, z , <br /> o , <br /> Property Owner's Name: (.4/..e A-L4..e-e. =' <br /> F. <br /> Z <br /> Property Owner's Mailing Address: a 0bc 5-,„.4 Rd Shed Lake /,I / ✓5i7/ I n ' <br /> /� ]_ City State Zip 4 <br /> Property Site Address: �)ID0 I /V D - c'6 V rte/ l^a n e- <br /> ' '' N <br /> Contact's Telephone Number: ?Lc—iMo —oo3q c. <br /> 0 <br /> Contact's Email: Q,l bti�' rM51 & f-ry u 1 N <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 <br /> @BurnettCountyWl.gov <br /> P w <br /> Legal Description of Property: NE Yy c' 5 .Y.1/ 4' <br /> Section#: 3 I Town#: 3s N Range#: i 41 W Town of: b e l„ey <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach fax system property page.* o e <br /> Tax ID#(1-5 digit number;found on tax statement): 35 77 <br /> -i W <br /> 1 <br /> Proposed Use of Structure/Aldition: f7�'om� <br /> Anticipated Start Date: / S pr�rr`o Mai. 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,_, <br /> fanner. 6..or'.to pe VJ t <br /> Building Contractor: 3 tit n e(ac/i' Sewer Installer: ///,,,e/$al <br /> Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,_ <br /> /11c-6- c0 $etbcckS <br /> a /veil,1w ►io - o e 3 beets-co/ 5' ? 5 -a3-2,5 <br /> ob n met/ inc , Art'✓e cress: weR.,'c+ / .� <br /> x Fee Rec: <br /> (irct;f(CgQ aveA., o Check#: ah <br /> )1;5 e rr v3 rvi-eek -$. n4n o-c a . yni re5;Lenc e. z <br /> 0 <br /> Q �f m <br /> Date of staff site visit: 5 f [/�3 Initial of site ' it staff: T/ < r— —��J <br /> APPROVED BY LAND SERVICES OFFICIAL`;L� & DATE:5/4423 y4 co co �' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a <br /> 0 <br /> --< o C — lJ u U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . w N <br /> Pagelof5 < C.a.) <br /> Burnett County,WI Land Use Application—Rev 12/2022 0 ? N <br /> v <br />