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LAND USE PERMIT APPLICATION — Burnett County, WI 0. r <br /> Applicant Complete All Sections Below This Line ; w <br /> C. <br /> Permit Types and fees:(Please,check appropriate boxes) >" <br /> Y/ v <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \` <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150j- <br /> 1 n <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c w <br /> Filling/Grading $150 Boathouse $500 <br /> s, <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 to three times the normal fee. ` <br /> b*Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> II* <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: Lk) 1\i o rM 1-. I . ij€(1,4,P ( 'T' <br /> E. <br /> Property Owner's Mailing Address: 2 11 'A1\12,Q c . cil tULe Q'ii,, 1 W 1 59 I43 w n rt. <br /> "City State Zip ° ' <br /> Property Site Address: c�I-{3 5 6 S iA1 e Its o f S 04,�j S 1-Pil W( 54 �9 o s <br /> Contact's Telephone Number: 11 5 — 6 to Io - 401 A/ (..-Pat'� <br /> i d <br /> Contact's Email: di-, b C�., A-C €C t;) jf 1G(I ► C.(71� <br /> **If staff has a question about this application,you will e contacted via email. Make sure your email address is N ,o <br /> legible and your email provider will accept emails from the following addresses: (i4BurnettCounty.org and ao <br /> @BurnettCountyWl.gov 1 <br /> d <br /> Legal Description of Property: �(A) ti W _'' Ni iv 9 3 i d t � Li LA 0 I '. E X S de AC <br /> Section#: 1 r Town#: b N Range#: II W Town of: r 1-05 r„ <br /> *Attach additional page if.needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* s <br /> Tax ID#(1-5 digit number;found on tax statement): a <br /> (�O LI <br /> a 5 <br /> i , y C <br /> Proposed Use of Structure/Addition: r NY 1 1`t O Y111 `,` <br /> Anticipated Start Date:'5rayl c 19 Iaoa 3 ( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) " �� <br /> Building Contractor: S 1c— Sewer Installer: w etcie V I IY\ % _r—__ <br /> x <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 <br /> eei aII 5 64 <br /> °owe(It Ao 1- --r2 CtCe ei ? beciov er 6i911/'2 3 -go <br /> g Fee Rec:_ a <br /> 5 Check#: -1 <br /> m <br /> a J LJ <br /> o 6— <br /> In <br /> trt <br /> u�u <br /> Date of staff site visit: !?3 /23 Ini ' is of ' e visi sta f: I -! <br /> n a, c D <br /> APPROVED BY LAND SERVICES OFFICIAL: [ Z DATE:5/as/2-3 (1' `- <br /> OO o <br /> Page 1 of 7 s, o <br /> Burnett County, WI Land Use Application —Rev 5/2023 "` i co <br /> 0 <br />