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LAND USE PERMIT APPLICATION —Burnett County, WIcr <br /> a <br /> Applicant Complete All Sections Below This Line CD w <br /> Permit Types and fees:(Please,check appropriate boxes) <br /> C�I \ d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure � gfl �; ---- <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 V <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� <br /> e 3 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse p <br /> $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o w <br /> Filling/Grading $150 Boathouse $500 <br /> 07 <br /> Solar Panels(Stand alone or roof mounted) Si Sn permit Fxte sion 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 /> b <br /> *Communication Towers,Camping Permitssigns require a i erent application orm;see corresponding application,and fees. <br /> i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name: (1.E1 ( .6 >v <br /> p2 <br /> ��rr� a � <br /> Property Owner's Mailing Address: 7'1 $ t/bw / o�p• 1- Spern/iv wL slim <br /> `‘ <br /> 111 n� City State Zip k' <br /> Property Site Address: 6 kMt <br /> o c T1 <br /> Contact's Telephone Number: b j Z/3 b 0 —g)q P/ /5$ - V 9" 9 � a r <br /> Contact's Email: IY)t bI( rIiVP�, Ce"✓H mebl i e Ii e . ' CD c <br /> **If staff has a question about this application,you will be con ctevia email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and e. <br /> @BumettCountyWLgov ao <br /> P. <br /> Legal Description of Property: g--1 y 2 g t tr4n-rty ad A 5. <br /> Section#: '3✓ Town#: 40 N Range#: /i/ W Town of: .e'o . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W C.JJ f <br /> Tax ID#(1-5 digit number;found on tax statement): / $ g 3 2- t7 <br /> n .-3 <br /> Proposed Use of Structure dditio 5 GI'el, . Ir a r-cm <br /> Anticipated Start Date: J-ih,Ly 7. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <-C <br /> Q <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> —4- -4 ibrI ht1- 4.0 vYlutas-e_ - nutty u-r q loodA1A0YIS• 1 -tu IS x Fee ReciH <br /> SQ,YIt-Ev✓`1 (fie-rmi-I- 4WIy28. mr <br /> o Check#:)42.1f q <br /> z <br /> 0 <br /> Date of staff site visit: -7 (12 f2.D2.. Init. is of site v' •t staff: ( ' t, J <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: 7/l7/ 3 rzisu <br /> y s <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <3 CD r 0 <br /> z m o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br /> Pagelof5 rn3 w <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 <br />