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• LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> N N <br /> Applicant Complete All Sections Below This Line 8' w <br /> CD I <br /> Permit Types and Fees:(Please,check appropriate boxes) z; <br /> w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 E. <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 /> 111 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F. <br /> I:% <br /> Filling/Grading $150 Boathouse $500 c <br /> w <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. q A., <br /> ., <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 L. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' ' <br /> 0 <br /> Property Owner's Name: o <br /> o Property Owner's Mailing Address: �� t 5 38 t I ^ / <br /> p � g a-��a t•�r���t1 � I�.ze-1 C�e..� �; � n <br /> 1 City State Zip '' r <br /> Property Site Address: Ki der LA 1 ek.n ;.rul . W\ 5+%3 0 - o y <br /> onn J' F <br /> Contact's Telephone Number: 'r `Gj - ` -ig"I T�L( 0. <br /> d <br /> Contact's Email: byl 0.(1 IfID f..0Pn O+GhcCcl eri a , (,rs m a <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o 00 <br /> @BurnettCountyWl.gov ao <br /> Legal Description of Property: Lit O+N€. k (1 0T G x 1 iE e a SuaV'e.j I I l&p *SU.2 7 ,q• <br /> Section#: 1) Town#: LA-' N Range#: (b W Town of: 5.i:(SS <br /> , ' ,Lcip i <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3.Sg.3a y <br /> Proposed Use of Structure/Addition: b i n CO <br /> Anticipated Start Date: 4 I 1 (D-3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ W <br /> Building Contractor: pO3 f But:lea(S Sewer Installer: �055 lo)l � 0 r v) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I eel- A I� Ze76eirc`t <br /> cks2 ,(� ,.�lno+ ee I G becl✓ ) Pei 5 1/?3-71 <br /> in <br /> Fee Rec: d_i_} <br /> o Check#: ,239 <br /> m <br /> d <br /> r <br /> HDate of staff site visit: 6/ L5/a_3 Initials site visi taff: e <br /> APPROVED BY LAND SERVICES OFFICIAL: ,Q, DATE: 6 ii 6 b 3 n. . [NI]�(�}) <br /> CD C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 7 <br /> r N n o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -0 �_ <br /> Page 1 of 5 < �' e''' <br /> Burnett County, WI Land Use Application-Rev 3/2023 = L` JJ <br />