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to <br /> • LAND USE PERMIT APPLICATION — Burnett County, WI L <br /> 2 <br /> b <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 <br /> 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.)I 1 Sb Addition/Alteration to Accessory Structure $150 c..1 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 i <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 W <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once)_$100 1. <br /> NTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> , s require a i eren appication form;see correspon ing ,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' I• <br /> Property Owner's Name: NQ, Q,ri 14Q.IN1,0 f— Io <br /> x I <br /> Property Owner's Mailing Address: to 3 7 c /Ott ,4-'Q. / I t t Pa�T inn) S s O' 1 In <br /> S City State Zip rn <br /> Property Site Address: o�D 7 O f DQ Y LY W/ 5 t-f t<o) o N <br /> Contact's Telephone Number: (QSI 165 gq ( Cl.CD <br /> Contact's Email: ► 1 1 CAMSA" f(4(,Ci )UY1 Q 111/ a • Celle\ co <br /> **If staff has a question about this application,you will be con cted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and I °Q <br /> @BumettCountyWl.gov <br /> b <br /> Legal Description of Property: E. t <br /> Section#: 3 3 Town#: 3q N Range#: ( 44 W Town of: Ru..s k <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W w H H <br /> g 1 (0331 , I (a338 y ° <br /> Tax ID#(1-5 digit number; found on tax statement): d <br /> Proposed Use of Structure/Addition: >QQrtlo(L W'►1� w <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W 7 <br /> jam,, /� �9 �9 <br /> Building Contractor:Prernr Poi 61 tt 9u Q. I td $ Sewer Installer: tJI A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> C <br /> - .-1- is S-NacS 1 <br /> - NO �°( 1(1111W halprfa--idn x Fee Rec: CP <br /> lice ()2onu-� A 2e,O ed -Co( Carlo coTkik Ras b4 3o 123_ 04 Check#: <br /> m <br /> •ACC 65 or( 5.k-Akt.Avrt5 4160 epac tA z <br /> v <br /> m 0 <br /> Date of staff site visit: 12 3 �Initials of site visit staff < ._.�C r <br /> —7 d <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: 1 /17 f2DZ..3 r L_ i1 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 0 CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT fg _ ^Y C <br /> �� o e <br /> Pagelof5 rz B .. w <br /> cp <br /> ff <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> a <br /> L . <br /> b <br />