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LAND USE PERMIT APPLICATION—Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 5 w <br /> Permit Types and Fees(Please,check appropriate boxes) a' <br /> l/"Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V s <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/industrial Structure $200 <br /> / O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 `�� 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° \5t, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> Filling/Grading $150 Boathouse $500 (T‘)) <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? "kr <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ,( <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o oz <br /> • <br /> C1 <br /> Property Owner's Name: f e T / f. Te re.SSCt- 8 /ee,5 M0. <br /> o <br /> Property Owner's Mailing Address: 6�,)3 0 <br /> /'/5 r� 51� N �u j0 r -'r2 5�O3g <br /> • n <br /> 11 j Q d 9 City State Zip 4 <br /> Property Site Address: 6076 Aks //? Le T1 WeL s�er IAA ' 3Q93 ,� o - T <br /> Contact's Telephone Number:Je F7 t G S/ 70 - 6413 / a U <br /> C7 <br /> Contact's Email: j eifbleC5 e0 3yna.t Cpvrt CD <br /> :: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N d <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and = <br /> @BuettCountyWl.gov w <br /> m <br /> 0. <br /> Legal Description of Property:07-0/8-D .3 9-/6-0/-3 U'-OCO-CJ!$JOIN R. <br /> Section#: C7 l Town#:3 g N Range#: /6 W Town of: (l e In n Oft <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C <br /> 7-) C7 <br /> Tax ID#(1-5 digit number,found on tax statement): //Q 3; <br /> .-1 _� <br /> LL// <br /> Proposed Use of Structure/Addition: !/O M � /Ga r 44 <br /> Anticipated Start Date: 5-5 aodp 3/ (Home/Cabi?7 Commercial Busine/�ss;;;Bedro/omm;Deck;etc.) VJ <br /> Building Contractor:Gary Sir'C/7fte 7/S 996-.)S70Sewer Installer: /7�j a /'(,,y7$ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT AS raTECT TO ALL CONDITIONS LISTED BELOW: ,_ <br /> O, I!ill a - 7h, ocr be4,044s per 54 iv.”- <br /> We--,.r {4u51- be ✓N G� ;ill U t V i Vvr7 IS e54g'bl;sliel <br /> � I � I � <br /> be fedot12 (/(,�1_D GLJuVl.ktl.o4 • Fee Rec:46�c1 <br /> � <br /> o Check#:ei 3 <br /> m <br /> 6 <br /> Date of staff site visit:5/l L' p3 Initial of site isit staff: HFmi <br /> .__) <br /> rri a <br /> Ind <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5�IS/�3 rn X. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o 0 <br /> N0 u"u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3= o ccrri 0 <br /> Page l of 2 1� `"' <br /> Ind <br /> Burnett County,WI Land Use Application—Rev 12/2022 d a <br /> t.a <br /> v <br />