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LAND USE PERMIT APPLICATION — Burnett County, WI a 2 b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) 1 • d S6 <br /> Ul <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 "1 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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 t�I <br /> Filling/Grading $150 Boathouse $500 �' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . <br /> 4- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. 'D <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. II <br /> r co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name:r161:a e-r A- Otsi-c,\\e- 7:).0 C b • c 1Nci_ , <br /> Property Owner's Mailing Address:R 0 ?::)o)t` 3 ��t GLUI V C g O - n <br /> � � 'y�'p ` � � ' <br /> Property Site Address:1 e G Gd 0 t'� A ' F <br /> �i"W V I 1 @ t 5Zi o P <br /> Contact's Telephone Number +6 ° i ' ---16 & ° e) / -7' 1),s__.). <br /> PI ,�^ C7 <br /> Contact's Email: Y h , A\'� 0 F/ V�a r 1 I LI' r 1' ` `D <br /> **If staff has a question about this a lication,you will contacted via email. Make sure your email address is N b ',..,) \ <br /> legible andyour emailprovider will accept emails from the following addresses: @BurnettCounty.org and °a <br /> g P g• <br /> @BurnettCountyWI.gov I I /� C r <br /> Legal Description of Property: {-mac I ` `- _3 `r`�)• ( ? 12 c7 <br /> Section#: a9 Town#: �1 N Range#: /6W Town of: w 'S 5 ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* (p H <br /> Tax ID#(1-5 digit number; found on tax statement): 3 I-1-'7 i g <br /> , W <br /> Proposed Use of Structur /Addition: ex-i`.5 Gam` 3 N aZq - . <br /> Anticipated Start Date: C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) , <br /> 1 <br /> Building Contractor'(! Cr l Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND S RVICES STAFF COMMENTS/CONDITIONS ONLY Pz <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> gee/ellk ir.Il 5e -5 <br /> 3 loci 1 C/14;i1 rS ✓I eO D✓1 jC 4':C ?R�II( I� b iofi/P3 , •. <br /> P Fee Rec: /5 <br /> o Check#: f Fl fJ <br /> t $32) `—C./Z.- / O'I/ <br /> z ._ <br /> rA <br /> ni <br /> Date of staff site visit: J Initi is f site v it staff: Hi:� < <br /> ) n gu <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:Sh'2/r�3 tn a cc, ff <br /> 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z < C <br /> ff <br /> -c o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , N <br /> Pagelof5 < 3 c. <br /> DI CO ff, <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> a �L J. <br />