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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a I. <br /> b <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> C7 � <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U\ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n � <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o O C <br /> Filling/Grading $150 Boathouse $500 .» W <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> iv <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ( / ()OiAj(,r Q' <br /> Property Owner's Name: \1�k l 3 u4nel, 4- tYl oll .S .;y, +J• o <br /> /' �j a �r�S30 t <br /> Property Owner's Mailing Address: /03 y / �.t' -C..'° N.A `'i LIT <br /> City State Zip 0, <br /> Property Site Address: 4 4 P S Priln'C__. 06.1 x <br /> iT <br /> Contact's Telephone Number: - ' 15 '� („ I ,)-1 ( jn (03 r�ui� .3 1 -� c <br /> (� d <br /> Contact's Email: C`Xl I \}ems— c,,.,,mot C,M S 0 . C..31(Y\ �% <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 °O <br /> @BurnettCountyWl.gov oho <br /> i 1 <br /> C� �� <br /> t. <br /> Legal Description of Property: U f S I 1 C Ca IT N l C6 3. <br /> Section#: Town#: LI 0 N Range#: W Town of: U►�r <br /> 3D g 7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f , <br /> Tax ID#(1-5 digit number;found on tax statement): 3 6l q 8 0'-3 <br /> -�I <br /> Proposed Use of Structure/Addition:De CA 2 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: G c <br /> z J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -_ <br /> i meek- a. ill $eT ac 5 <br /> Tat? Sile. <)-72 be <br /> veJ <br /> l I due �/e eKt5� IA Fee Rec: 6D <br /> ,5 r5 al k 1 D �D (,l rr ff o rr'' <br /> 1 (/ etekicthic-s U>S •SA D e fig 10 5 d — = Check#: aogb <br /> ��e°'� pine✓U/r5e S,�eS °��� �rN►• cd a , �` d <br /> c:7 . 4cce55V 5 cka-e• E <br /> z <br /> u <br /> / / m l <br /> Date of staff site visit: .-1a/a.3 I 'dais 'f site vis' staff: x <br /> APPROVED BY LAND SERVICES OFFICIAL: /* -/ DATE: 5/��/ 2 3 y CST> <br /> VEI <br /> V = 70 <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o z �; N Efii <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 5 N o <br /> 63• w <br /> Page 1 of 5 rTI< r, Iffl <br /> Burnett County, WI Land Use Application—Rev 3/2023 v ' �` Jj <br /> a <br /> 3 <br />