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v, ro <br /> LAND USE PERMIT APPLICATION—Burnett County, WI <br /> a <br /> Applicant Complete All Sections Below This Line o w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) °' <br /> 13 <br /> n O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> V Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o _ <br /> A. Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o W �� <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. fD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P. '' ilk/ z <br /> Property Owner's Name: .4 /i i 1,r--; L n p C)a c i' / L{tit- L,aae'4 g t .o _ <br /> a. <br /> Property Owner's Mailing Address: , 03 /4' /I v i .,J J d it 1u/ C, 62— n • <br /> o <br /> City State Zip E <br /> Property Site Address: 1593 <br /> i)('nh a l?, Lot Apt U t- S i,-€h K 7z_ <br /> / 5 o Contact's Telephone Number: 507— 2, i 0 5 3 Z-. , <br /> Contact's Email: -�l/p 4tA)6 q / e 6 4 Ct,i 1. G. d7?^i r `� <br /> **If staff has a question about this application,y ill be contacted via email. Make sure your email address is N ro A <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and o 00 ��j <br /> @BurnettCountyWI.gov onn <br /> Legal Description of Property: , (Ott!I t 01 S. <br /> Section#: / Town#: 3ir N Range#: [ W Town of: _ 'Q 'p (S cA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N o 5 <br /> Tax ID#(1-5 digit number;found on tax statement): ,Yq I <br /> d Proposed Use of Structure/Addition: D-Q,(;,lc — 5-4-A, (49 ---oc 3 ,O 2-" lik L <br /> Anticipated Start Date: /nal (90 L.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Kt✓i n in i I Ito— Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY lc) <br /> THIS PERMIT IS SU ECT TO ALL CONDITIONS LISTED BELOW: <br /> reel- a (( 5 s <br /> did V P -,23v;- (9,�d,'hwi's <br /> I Fee Rec: 1 Q5 <br /> 6 Check#: 675( 1 <br /> r-, <br /> r <br /> - <br /> C=.J <br /> Date of staff site visit: 6, 1)31 a,3 Initials f site isi taff: il, - <br /> ,i(- L�/ 3 !: tI U. 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: � % DATE: 7// ` ? P w C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . = w F <br /> 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ' N Q <br /> Page 1 of 5 s= Eril <br /> w <br /> Burnett County,WI Land Use Application—Rev 5/2023 - 0 <br />