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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 _ Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 _ Addition/Alteration to Commercial/Industrial Structure $200 t 0 <br /> "24. 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 o i <br /> 10 <br /> Filling/Grading $150 Boathouse $500 cn ph <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P It <br /> iv <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. q <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r o <br /> .*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> o ` <br /> Property Owner's Name: 3-q A1e5 "A C( cS C1rO li\ AI om e^ o <br /> ,J t ��7� b <br /> Property Owner's Mailing Address: 9 I Ll `i Y - Alpe, ki, 16 <br /> � ,iob.I�5QC�'e � ✓5 ?2 \' <br /> ---�+ y�� City State Zip 4 <br /> Property Site Address: p(�b15-4'1 Cb1w' AMA KAI, 1�eV5K� 5 M 113 o y <br /> NWContact's Telephone Number: <br /> I a—a 75-53? 7 (nl4 l.e) —2 63--5-33 3 4110 (home) '� CD <br /> a' % <br /> Contact's Email: 3 M°4.4 er Q CQ,%k e t 4 e-iy � <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and g. 00 <br /> @BurnettCountyWLgov <br /> Legal Description of Property: LOT c C511 U (G PH 3 �10 Gw LTV I a ) -=. \N <br /> Section#:3 b 5- Town#:` -3$(11N Range#: A 15 W W Town of: LA RX L.G T I E <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Db o P <br /> Tax ID#(1-5 digit number;found on tax statement): CI Ha j�J <br /> I -i <br /> Proposed I Jse of Structure/Addition: 504 LAii CI (�7 r`�}e)-Free 41-A4 6' tc`11 , <br /> Anticipated Start Date: 7/5 /a 3 (Home/Cabin;Commercial Business;Beddoom;Deck;etc.) \A A *0 <br /> Building Contractor:Ch65+ v j " 54 114 S ilk, Sewer Installer: r'r\1 /f A `( r <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> sauia MO 6t u el L46/774�� (� <br /> us el -‘ �uctigrt a <br /> Fee Rec: S/�� i <br /> o Check#: -)/ <br /> m <br /> r <br /> a <br /> z <br /> 0 <br /> Date of staff site visit: 0100 Z 3 Ini ' of 'te visit staff: i4 r t <br /> J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 01/2.02,3 <br /> „0 <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF @ c 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1� N <br /> Page 1 of 5 w 1 <br /> Burnett County, WI Land Use Application—Rev 5/2023 Thid <br />