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• LAND USE PERMIT APPLICATION - Burnett County, WI a t~ <br /> b <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) E <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> „ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C'. 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 9..Ng <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> t. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < D <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F fr. <br /> i <br /> Filling/Grading $150 Boathouse $500 <br /> En <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. 1 <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. g v. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> o I. <br /> Property Owner's Name: NO&ti$ (4,v P.f'P 2 ES =' <br /> °o <br /> Property Owner's Mailing Address: 2y 1 I1 YEA) Ao. __ • - _ E. n , <br /> City State ZipEn <br /> Property Site Address:33'1 bLifoiA6 29Z.00 E/ 5j 8W(0.,1 Au .R .3, ,+�qr&lkV VAC %-iH,1530 o <br /> Contact's Telephone Number: (GI 2-,$,3d - cows S e-rig 46-.1sc,1 " <br /> d <br /> Contact's Email: S'G i Else Comcns1. Nel- `°' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and V ro <br /> °O <br /> @BumettCountyWl.gov 00 <br /> d O <br /> Legal Description of Property: Ls+ I CS A q 9 5 V 2-1 P3olo R. <br /> Section#: 5 Town#: I/(0 N Range#: 1(p W Town of: Cot X LNb <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> i 5 <br /> Tax ID#(1-5 digit number; found on tax statement): 3s qzq ) <br /> 5 <br /> Proposed Use of Structure/Addition: Pux)F eve_ t�Eck y <br /> Anticipated Start Date: 45/\P (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: •ceLP Sewer Installer: % N <br /> M <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i\x, (k` <br /> /9r1t, peem ,1- /rS 61‘ 5174 / 1 3 . i)pD St._-C !llOO cD(l/CAA� <br /> c e_fiC/ . /f a s 2-X I S ?4fl5 4-eci aH a 7‘i%O e.)(i. 7 'if,. <br /> x Fee Rec:� C" <br /> � �so y <br /> o Check#: <br /> m <br /> Date of staff site visit: a/ Z��Z 3 •I ' •' is ite visit staff: m �I <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: ØØe2 .3 <br /> rn g = 0 <br /> UPON APPROVAL: APP 'ICANT MUST POST COPY OF a = Wl <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 4 <br /> Page 1of5 3 EN <br /> Burnett County, WI Land Use Application—Rev 3/2023 (.. . JJ <br /> 3 <br /> �o <br />