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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line ' c w <br /> o. ' <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> *" <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> V 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"") N <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c R <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> t 11 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ Xt\ <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 /> Z <br /> Pro ert Owner's Name: w �� <br /> P' y 4 /.,-t y d�nd Lc 4>1 7n C lei.0 cw�' <br /> oo <br /> Property Owner's Mailing Address: 9 70 5" I ' fl! /I4 fh. k 6r. e /1/4/ 1 T5 6? w <br /> ity State Zip "' <br /> Property Site Address: �- 7 6 13' 5- <br /> 0t,'t1i /2/vtr Aowd Qom„Ivry wL f y.5' o <br /> C <br /> Contact's Telephone Number: 76 j - 7 79 — 9/oZ a <br /> C7 <br /> Contact's Email: :D , <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.d <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °" <br /> @BurnettCountyWl.gov <br /> AlLegal Description of Property: Y . sF sw y. <br /> Section#: 2 9 Town#: ill, N Range#: /7 W Town of: flh ,'o,, v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c x <br /> Tax ID#(1-5 digit number;found on tax statement): 2-5—/4 3 d <br /> Proposed Use of Structure/Addition: 5 t®r'.cj e 541 <br /> l <br /> Anticipated Start Date: JV I1 2c)-3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: AI,4✓fca++ 5 "cJ' Coef"i t ,Sewer Installer: <br /> IC) <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> '. ..."! 'S-6 <br /> l'iet* ail Se-1-o4 '•t <br /> 0 Prs cil eel�-s fla4— litinh,- SA4 tiziArevi <br /> T p�"��— and So. <br /> --1--/� Fee Rec:15214)— <br /> v <br /> �� ��,� r, Check#:CCall <br /> • <br /> 0 <br /> / � e< a <br /> J ^ M m <br /> HI <br /> Date of staff site visit:1/I 0 �3 Initials site v' it aff: f{ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/I?/a3 ! I i 1--. <br /> o <br /> Page 1 of 7 3 i ry (41 <br /> ra Burnett County, WI Land Use Application—Rev 5/2023 ` g� cN <br />