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LAND USE PERMIT APPLICATION—Burnett County, WI c b r <br /> b <br /> Applicant Complete All Sections Below This Line o" to <br /> Permit Types and Fees�Please,check appropriate boxes) fl- W <br /> t7 <br /> ''s(�/ Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> 4 CD <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 t `` <br /> Filling/Grading $150 Boathouse $500 , <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 , <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ,4 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> a' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o z °S% <br /> Property Owner's Name: 1.--11 T.k1 Af C& O Hynayori AO *tow kiyotec I2C- o N <br /> Property Owner's Mailing Address: VD 'boy,. k-1M LAY-eiA t 'L 1 55041-k n <br /> `^ I Ct Mate Zip <br /> Property Site Address: ADR-n\Ou, <br /> Contact's Telephone Number: �l �q �-� a, -:y E. <br /> Contact's Email: L Pj 2.-1 ` ve,_ GD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and Ro <br /> . <br /> °C <br /> @BurnettCountyWl.gov <br /> '"o <br /> Legal Description of Property: God 2 C M1 / / iQr /56r <br /> ()C? ,,_ <br /> • ' <br /> Section#: 2-2) Town#: 0 N Range#: `1 W Town of: 4912 tj Kite", C <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o y <br /> ,fib w g <br /> q5 <br /> Tax ID#(1-5 digit number;found on tax statement): 5 t <br /> H <br /> Proposed Use of Structure/Addition: 1~n N <br /> Anticipated Start Date: <br /> h J j/0 IA 1 z2p (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: .1\,) A ) Sewer Installer: N `I A <br /> z 8 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> �n 11, THIS PERMIT IS SUBJECTBJ TO ALL CONDITIONS LISTED BELOW: .� <br /> V Pi�/ lrl a S ALt/74 Jv2Go`l 11 o X v <br /> ,D Ci/'Gt�l� �Y1 /^ <br /> c-H S4c•74 of /7 / aD ell) r,. <br /> ti l- 7� e_c ae e_ Z. 6 elm .1.);.)=° <br /> � � s P ev' S4�/�r�/ ��'' I � � Fee Rec: <br /> P- S d�_00^/DV 1 L / � Check#: 4q�e� <br /> 3 I�r�'vel�aa �v wle�T W61 <br /> 'i /elyhi-hi-de/re/KC-CS �Of► 0///Z9Z <br /> D y ig <br /> Date of staff site visit: 7/(o7Z0 Z 3 Initials of ite visit ff: �j ---7 <br /> n �� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: //� Z3 °rn r' - ---'lr;r,1 <br /> ' Upll <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <5 z <br /> !' SIGNED PERMIT APPLICATION IN PLAIN SIGHT .g nea <br /> CI CsivkT ' u DG i.,4 yec 4 ' 4',/, Tn e,l j^ ,eeM IV; Page 1 of 5 N <br /> Burnett County, WI Land Use Application—Rev 5/2023 d a co <br /> L <br />