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LAND USE PERMIT APPLICATION — Burnett County, WI to <br /> a <br /> 4 <br /> ,. <br /> Applicant Complete All Sections Below This Line 0 w <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> X Accessory Structure(Garage,Shed,etc.) , $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 4- ►� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °• D <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) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. & r <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -. <br /> 0 <br /> Property Owner's Name: (jrr°a }{Pry^ ' o <br /> ti <br /> Property Owner's Mailing Address: 11741 ,kplr c Cool l e (31�,'h e /1N c �1E. n VI <br /> ,� -Fmk <br /> City, State Zip ° c) <br /> Property Site Address: (' J4 3 Ce4r 1 o7,1 T_�''e-eic f^��ela�e 1t o_ r, <br /> Contact's Telephone Number: t�1)- Yt (q 43 a <br /> d <br /> Contact's Email: � f her r a qm eir I : 611,'t :�**If staff has a question a out this applicationou will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and a °0 <br /> @BurnettCountyWLgov o <br /> pr,r �r q ..O <br /> Legal Description of Property: C 3-Iv 0?-�,)��� � -� j -��'S l��' -�}f�p �. N ^� <br /> Section#: 510 Town#: T 37$ � g N Range#: � W Town of:__Tad rn N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I� o k <br /> Tax ID#(1-5 digit number; found on tax statement): `a3 al? N O t7 <br /> Proposed Use of Structure/Addition: P9 /i / �., otvrier4siel <br /> 1 .-.'. <br /> z <br /> N <br /> Anticipated Start Date: Q-I.- 3 (Home/Cam;Commercial Business;Bedroom;Deck;etc.) C.s ,J <br /> pii <br /> Building Contractor: C MiFI fat@ !� �O')$ Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY - <br /> ..<:, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - Mee- 011)" X-4 oc <br /> i <br /> — NU--- or \\Kxxy .\ �O i-� 0, �' <br /> x Fee Rec: <br /> 5 Check#: 2e75 <br /> tz <br /> r <br /> Date of staff site visit: -(7 <br /> 1 2DZ3 Initials of site visit staff j - <br /> �r, ? ,; <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: —7 il!7 /2013 u'W C, <br /> , coo <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0, w <br /> Iffa <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Inni <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application-Rev 5/2023 d -2) <br /> b <br />