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• LAND USE PERMIT APPLICATION — Burnett County, WI a 1—, <br /> Applicant Complete All Sections Below This Line ° 66 w <br /> PP P a a 1 <br /> P�2ratit Types and Fees�P/ease,check appropriate boxes) <br /> /'' Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r. <br /> 1 ftv Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> 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 0 <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 tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - <br /> z <br /> JiJ n _ o <br /> Property Owner's Name: M��� ��N D 1 C`� o N <br /> o <br /> a. <br /> Property Owner's Mailing Address: i 2"1 3 C.00!S T 1 1 El 5 pbc N t RZ W‘ 59 Bo 1 1 I� w <br /> n <br /> �+ <br /> 1).0. <br /> City State Zip ,` <br /> Property Site Address: 2 5 I COO PA ri 1).0. I SP©o sE9, U.J I .5 y 8o ( M . c <br /> Contact's Telephone Number: 7 3 ej e a - \ 1 ©z CD, <br /> Contact's Email: rr a f b a l\ D r/1 S''(\ , C.0111 .4) E, <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro Q` <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° °Q it.) <br /> @BumettCountyWI.gov cm <br /> 1� p o 1...)Legal Description of Property: 2 C 5l Boy v0( a 7 P 7 6• d <br /> 11 <br /> Section#: 3-4 Town#: T 0 N Range#: ) � W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* k 5 <br /> Tax ID#(1-5 digit number; found on tax statement): 3(o 2 63 C7 <br /> y n <br /> Proposed Use of Structur /Additio n: '�O M E <br /> Anticipated Start Date:Jl3 NE/Addition: <br /> EI, vZ Ov)3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ) '- ) k <br /> Building Contractor: -30'DE PECK SewerInstaller: 1-1Opvto s SAND E, G,RZA1IC L cr. <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> C0 Y,eth Gc1( 56&.05 -� <br /> OD/yetl ,,s,�. Qc C a b'�� 1?e.t 5.0-23. 01 <br /> rt4.5. Attec . c45 o� V4 -a2-o1 /� Orr y Fee Rec: 31,►'Qt1i//LL,"G ^feSfd rti 11 k Swq le 1A$' 1 (9j C'Ni T 4 Check#:Lric <br /> t 214-1 1411 z <br /> 1141�3 m <br /> Date of staff site visit: it. 1 of sit vi ' staff: < inn' <br /> m a D UUB <br /> APPROVED BY LAND SERVICES OFFICIAL: , e DATE: 7//4/P3 co -� ,, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a <br /> (' U Y LI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Co= N <br /> Page 1of5 5 a wFill <br /> Burnett County, WI Land Use Application—Rev 12/2022 v (.._ J <br /> -a <br /> a <br />