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LAND USE PERMIT APPLICATION —Burnett County, WI cr <br /> Applicant Complete All Sections Below This Line o w <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> \/ Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 7 <br /> (` Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 V. <br /> Filling/Grading $150 Boathouse $500 , <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r` E. (9 <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. Ul 2 -fir <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 9 <br /> Property Owner's Name: /11 j c 1t'-e ( ok../v3 /11 e t•_S 1 tkC‘,✓c y .z: ‘ <br /> Property Owner's Mailing Address: 44 39 7r"�"2 z:P7- C_f X J a /'14/ SS/Z3 <br /> 8 <br /> ��O it, <br /> k C pp ✓. City State Zip Z <br /> Property Site Address: Veit,Z i led S'IDw/ , 1.t/. - S. ( -0 i o c .c.- \ <br /> Contact's Telephone Number: ( S ( 'Z — Z Z /J <br /> - 2 ► <br /> Contact's Email: m I v`^/'f Q,/te,t 0/11 ` r. <br /> r t <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N 'e <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and 8. <br /> @BurnettCountyWl.gov "° <br /> /1,, / ,p ) 4 t7 <br /> Legal Description of Property: v,ICE / '��CrN 2 r C /k—s�C" 1 S 6. <br /> Section#: L Town#: L4 0 N Range#: K.._(Li W Town of: Sc© +"('— ul <br /> •*Attach additional page if needed for lengthy description OR attach a copy'of the deed OR attach tax system property page.* o ; <br /> �1 <br /> Tax ID#(1-5 digit number;found on tax statement): ( 1 0 Z ((�� � <br /> J H ..) <br /> Proposed Use of Structure/Addition: N C V O C.k }c f ep/�-Cc e✓<S-� d 1 S tLte 3;M''^'Sw'f _A <br /> Anticipated Start Date: 6 l( t 2 ( ? (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) cC. <br /> _ 0 <br /> Building Contractor: I I Ce COA64 ✓c-11 0"-t/ Sewer Installer: Z___. <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> V 011,5+ 01 eet a II 5e-I-bee �t <br /> &.((ov'& � be (P(4ce( <br /> OA i 5 5f.nce 64 At e s le. as ek; <br /> Loci( <br /> 4 (-1 a 4 64 S GP1;c clr,nif 1 id l 10103 g Fee Rec: /Q'S <br /> Check#: 5-4,/d <br /> rri <br /> Date of staff site visit:5/q/2,--3 Initi of site ' it staff: YPe c== <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE //O 2 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ci <br /> o c Inn]SIGNED PERMIT APPLICATION IN PLAIN SIGHT a, c <br /> Page 1 of 5 3 (.0 <br /> Burnett County,WI Land Use Application—Rev 3/2023 <br />