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NI <br /> LAND USE PERMIT APPLICATION - Burnett County, WI g <br /> < b <br /> Applicant Complete All Sections Below This Line 5' P ta <br /> /Permit Types and Fees(Please,check appropriate boxes) a <br /> C7 <br /> xDwelling/Principal Structure $30J Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 bO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 k c <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> 6 r... <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. . <br /> o <br /> I <br /> Property Owner's Name: 36E� I.ea c-I S/dd- a ,� G <br /> Property Owner's Mailing Address: a)'Iv) 5 f h l 1C17/J 14/ CianKl)ate <br /> L'z 51/J'1 ' n 6 , <br /> a� i City Zip ° "' <br /> Property Site Address: Ion�j t f j,I/ r rz n r 1�1% o N <br /> Contact's Telephone Number: L /9 - 4SS-- �3 3? a <br /> d <br /> Contact's Email: i 0e-, le/'d StiJI- & "dit ,e - 0**If staff has a questikn about this application,you till be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o <br /> @BurnettCountyWl.gov avv n 1J <br /> (( � <br /> Legal Description of Property: Lor �� <br /> 7 l��� 3 �� V D�. 1?./D C g�+ . <br /> Section#: 3b Town#: 3g N Range#: I!' W Town of: u/DOd h / tie./" <br /> *Attach additional page if needed for lengthy description OR attach/acAopy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): ) 9 Log a <br /> 1J <br /> Proposed Use of Structure/Additi n: H'C3f1'1(?, --II <br /> Anticipated Start Date: 3bp/g 3 (Home/Cabin;Commercial Business;Bedroom;Deck;et .) at,l L 00 O <br /> Note', se/it. nd 't/r p, <br /> Building Contractor: 3ce, R erC-h*kit- (Gen era) Sewer Installer: BGf/'nej elan. n /ny¢�(/�d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS JNLY z <br /> + <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> c meeA- all S4 Geks <br /> D„�e[(� � -7 e d abed 5fer sefv-3o% <br /> v <br /> i <br /> R�(e 5 opterepeb �crc ' aw � �, <br /> �krnb� x Fee Rec: 3,a`b <br /> 1 irb 15 kl ee C n? A W1- 1 CC/ISd y <br /> �e_(F ��T o Check#: 3c ., <br /> _cor oimecbj cf..° -1-14t_ 0/0414i i , Co P2IP.q. <br /> z _ , <br /> If m r <br /> Date of staff site visit: l/ c212-3 Initia of site isit staff: /'1 <br /> Fi a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 6/o2)/P3 E2 (T C 0 <br /> <_3 Z <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m - wt."' <br /> Pi Ufa <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application-Rev 12/2022 v 1......., .4 <br /> v, <br /> a <br />