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LAND USE PERMIT APPLICATION—Burnett County, WI 1:. _ . <br /> a <br /> Applicant Complete All Sections Below This Line = w <br /> Permit Types and Fees Please check appropriateCI. <br /> Gj yp � boxes) � � � <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 s <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 %\IN O <br /> Accessory Structure(Garage,Shed,etc.) $150- Addition/Alteration to Accessory Structure $150 1 -4 A?W I, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G" <br /> /Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° S l\ <br /> I/ Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 'o <br /> Filling/Grading $150 Boathouse $500 ! <br /> Solar Panels(Stand alone or roof mounted) ,$150 Permit Extension(1 Year Extension-Allowed Once) $100 " P <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. t <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. F. <br /> �l,� ,. rr z <br /> Property Owner's Name: �IGF�iIW �i�Fl -111�'�T Q o <br /> Property Owner's Mailing Address: ?�2y f//Tt v1 UrM MKE 5020 .5. ,' <br /> d l � f�4i,'aio in Nt R City State Zip <br /> PropertySite Address: � ���8 LAKE 4i,EZ 6-9�S�C? o tr <br /> y <br /> ` jj� Q a. <br /> Contact's Telephone Number: �� +a " $(PV'��4J <br /> Contact's Email: .1- a A 1-1 Nl� 61 1 H I\iv/J\i CY' l--c)1 <br /> ...,::, <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 a �4 <br /> @BurnettCountyWl.gov W <br /> Legal Description of Property: tfrtAMOM /AWE- 6MC4E-5, ACir3 174.1S �. <br /> Section#: 306 Town#:TL fi/Y N Range#:R/I 4 W Town of: jc py'r— . <br /> ; -, .--, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 140 i <br /> Tax ID#(1-5 digit number;found on tax statement): I ; 9 72 <br /> `rig r t <br /> Proposed Use of Structure/Addition: PA-77 o 1 A.3 N <br /> Anticipated Start Date:epin fJ„ '-� (Home/Cabin;Commercial Business;Bedroom;n Deck;etc.) I1 . `'') <br /> Building Contractor: •SELF Sewer Installer: /Yt/7 <br /> z ^ , <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ;o I V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4s o-, jaaiet_ a , 4Le.-..0 4.141..eA--.0 <br /> V641241.- /)-ea-- . P"4-& g Fee Rec: <br /> t, _ n (�• j),_ 64 yzAe.... .trf) w <br /> zte.gte' ,6-ed- iy,,,r,„,..z.,0 L Check#: <br /> v4 44,0 <br /> z <br /> Date of staff site visit: /204Z 3 Initials of site visit staff: /' tir <br /> < co <br /> ez/ a hill <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: CP /ZOZIS La m w C n <br /> 67 /s ;i' Q74d us Ye,{ 1 0 y. - a �1 <br /> t Page l of 7 g o o w <br /> n z y,,2 3_0 JrQ Burnett County,WI Land Use Application-Rev 5/2023 w <br /> U <br /> (Tull <br /> L` J <br />