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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) � a W <br /> � r T <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 T- <br /> Commercial/Industrial Structure $300 `Addition/Alteration to Commercial/Industrial Structure $200 O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial), $200 Addition/Alteration to Butt ouse $150 r� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 `- 1t 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692( ructures $350 r-' <br /> o 3 <br /> � <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree timetthe normal fee. ,$ <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding a•pplication,and fees. CD 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> z <br /> Property Owner's Name: J Q r'a iv‘.) (r o LA <br /> QQ Tow-Grt'? $ <br /> Property Owner's Mailing Address: 6 ?U /J c t`o C O C.- Tru e l Nee j her M N 7/ w n <br /> p I a City State Zip 4 <br /> Property Site Address: 3 `!W L.0, icy A.,) 'e;n b�d r'y' Vay.� o y <br /> • <br /> CD <br /> Contact's Telephone Number: I)5 1 - afv 9 - C1 o 3 r7 '1' a <br /> d <br /> Contact's Email: iO 4-a r S i 4'•{P Y ® 1411.)c'' ' c --'�' II <br /> I= <br /> **If staff has a question about is application,you will be contacted via email. Make sure your email address is N `0 <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and °a °Q <br /> @BurnettCountyWI.gov I <br /> v <br /> \� <br /> Legal Description of Property:W -DLI FE F €O1A N DS LbT '1 . <br /> 5 <br /> Section#: 0\ Town#: D N Range#: 15 W Town of: 7CLO .S OnCID*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F V <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): lY 3 I 3H <br /> Proposed Use of Structure/Addition: Oct r c,. Q <br /> Anticipated Start Date: S�Sir i- v�-4)`)-3 ome/Cabin;Commercial Business;Bedroom;Deck;etc.) „C C <br /> Building Contractor: 1-6✓`u 0`"'i^Q r Sewer Installer: <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 /> -ND4-- -Cur h .m,O‘-al of On <br /> Fee Rec: / <br /> L l9st p x cr r ne eci ed -C-pr CCI..mpe,r SiQ(TaGaQ S- (_ g-t bk-f g I t/13. o Check#: (,„2Lf_ <br /> m <br /> . Ccurnfrf•wv) Kr ty,:t-i- 0..e19 it a +0 10‘.1 3 I I /23. <br /> ci <br /> Date of staff site visit: (Q /12./z0Z3 + Initials of site v' it staff: <m Ir�) I <br /> 3 Il �1J <br /> n I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: (E/23 2 Z 3 n <br /> CA <br /> m 2 C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT j K w �' <br /> Page l of 5 ri <br /> CD <br /> Burnett County,WI Land Use Application-Rev 3/2023 0 - - ) <br /> 3 <br />