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LAND USE PERMIT APPLICATION—Burnett County, WI ro <br /> y N <br /> Applicant Complete All Sections Below This Line o ,��, CA,/ <br /> Permit Types and Fees(Please,check appropriate boxes) a U.)t7 W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 nIs, W <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <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 c <br /> Filling/Grading $150 Boathouse $500 <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 n <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. r i`D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P. _ a <br /> z <br /> Property Owner's Name: i L h Of ) H e I Z 8 <br /> Proa Owner's Mailin Address: <br /> p g l- q gc- F=r; f ba✓I)25 Ave_ ZC 4 sc�'�l iv r <br /> / City State Zip E <br /> Property Site Address: `l �� l I� P S T I tt , D�t vi b i]�� (, it, o _ <br /> Contact's Telephone Number: V 1 2 — O L/J - 0'3 c <br /> r. <br /> n In <br /> Contact's Email: ► 1 h e l )1� r e ►� e l'' c y-LU v'M 1 <br /> **If staff has a question about this applica on,you will be ontacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses:@BumettCounty.org and =. °0 <br /> 5 <br /> @BurnettCountyWl.gov _ 0° <br /> � 1-4 <br /> ,' d <br /> Legal Description of Property: rvrol eL�� ��r k �55 e�s0 r 5 ;f��� W' 7 �• <br /> Section#: 2:1 Town#: y t N Range#: I W Town of: 6 14/1 S,S a, <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): 'a_'-7 6 O <br /> Proposed Use of Structure/Addition: l7 tO re-1 c:se <br /> Anticipated Start Date: U l y I ZO z?, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Se I T Sewer Installer: N N <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,.._ <br /> j7me6- al( Se+baatS , �� <br /> 0 v\-�r Inn 6 b1 -b ' , <br /> Fee Rec: <br /> c Check#: 47/0 <br /> m <br /> r <br /> Y <br /> z <br /> Date of staff site visit: ('I)O I a3 iy_i'ti of site ' 't staff: ki -- o r L J <br /> APPROVED BY LAND SERVICES OFFICIAL: oG .� DATE:W?// ?3 <br /> CR W <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 9 <br /> D o -V- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ',; C <br /> Page l of 5 :g " <br /> ffil <br /> Burnett County,WI Land Use Application—Rev 5/2023 = <br /> Jj <br />