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LAND USE PERMIT APPLICATION — Burnett County, WI a to <br /> Applicant Complete All Sections Below This Line = w <br /> Permit Types and Fees(Please,check appropriate boxes) n <br /> C7 +V <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 :: <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ` O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F. U'l ! <br /> Filling/Grading $150 Boathouse $500 , <br /> D <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z. (� <br /> 0 <br /> Property Owner's Name: k. 5-- --�iity-�k.) Y�,� t o <br /> Property Owner's Mailing AddressR0 7� �, t-Gt(-(7tt) IR,-/J.eJ1- a �A�Vg, fit' ` • n M • <br /> ))�� `� City State?Zip cA <br /> Property Site Address: 7,2 F ti�,GiiC. �12r1.d. Sa vs,,, t,V,;. !�-Le$6U 52(759 o y ' <br /> pp m - i <br /> Contact's Telephone Number: kj J Lq -�'/ � a <br /> d <br /> Contact's Email: Mc. L 1 rn i.,N <br /> Q rvvCl_.A I' e-c fD <br /> **If staff has a question about this application,you be contacted via email. Make sure your email address is N 'CO <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and °� <br /> @BurnettCountyWl.gov 1 q p <br /> Legal Description of Property:L0 � S l lli LA7 I a % r I P CS <br /> Section#:O 3- Town#:IV N Range#: F 6 W Town of:0/4-,1,1 L4 ,(-/ �, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Q H H <br /> -6) <br /> Tax ID#(1-5 digit number;found on tax statement): J 2 V,' d <br /> CA.) <br /> Use of Structure/Addition: a�1 S`-'V C AA-C' <br /> Anticipated Start Date: A T r' (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Ci tr <br /> Building Contractor: Sewer Installer: i d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z 6 <br /> Pzi THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> skI ,, rJ- j hum a, ita .4EA'c)� <br /> 5) on.e`t, /1A- ive-eci 2 be"f5 pers P1*266C�7 �x Fee Rec: /.. —12°0 <br /> N <br /> o Check#: 5 71 <br /> m <br /> Z <br /> /-/ 2 ]Jr o J <br /> Date of staff site visit:6 I'&` 3 Initi s of site visit staff: �1 r/ <_ w <br /> f � a Hi <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: 5/!9/23 X �� <br /> m <br /> usmc n n/�/�-�J�[ <br /> a < z -c VV� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 1 - Uti <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w c4 <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 v (...L... JJ <br /> a <br /> x <br /> -9 <br />