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LAND USE PERMIT APPLICATION —Burnett County, WIot r <br /> cr <br /> 1.1 ro <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Piease,check appropriate boxes) a C ..� <br /> Dwelling/Principal Structure '*'$300 Addition/Alteration to Dwelling/Principal Structure $200 `, <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -S O <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o •I' W <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 c A. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 7 <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> tj I 3 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: Pet}r,C/- # /ti c I ( I„/Q I I o <br /> o <br /> Property Owner's Mailing Address: 70 3s r. di -o i.,.10 ✓0( .0 r e%7 Lilt 4-72 <br /> n Rs <br /> / City State Zip ') -NC r-' <br /> .Property Site Address: ?0 3 ti-. 44 i w'I P' 4 Ss'i e,/ •c N <br /> Contact's Telephone Number: ?I: 5 66 _ 0,�O L4 rz- <br /> Contact's Email: O 0-5�S it) C e i./ v c / ji e 1• e� CD <br /> d <br /> **If staffhas a que ion about this application,you will Ile contacted via email. Make sure your email address is N b <br /> U� <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @B urnettCounty W l.gov rig <br /> Legal Description of Property: NE r 1/F F Y J I 2 w I/ . 4 <br /> Section#: 3,? Town#: 31 N Range#: ( 6 W Town of: Al i. l- N0.4/ T <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N W <br /> W G <br /> -Tax ID#(1-5 digit number;found on tax statement): ,_ / 7 <br /> - to <br /> Proposed Use of Structure/Addition: S-I-orc_5 ti N <br /> Anticipated Start Date: 7/i/ ) 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: P 4--,c 4 M£..,.3,--L_,Q? II Sewer Installer: > - 0 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ._. <br /> - 11 .eA NA S-t,-Hbcua-S <br /> Fee Rec: 6012 <br /> ,.(1?, Check#: /Ulf, <br /> m <br /> r <br /> a <br /> z , <br /> o <br /> t. <br /> l J <br /> �1�!VD trix w <br /> Date of staff site visit: Initials of site visit sta < `�,�, <br /> 7 c. ` U u L <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 14/ zez5 `co <br /> � m c C n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 o N bili <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m w <br /> Page l of 5 <br /> Burnett County, WI Land Use Application -Rev 5/2023 d (.1....- JJ <br />