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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a _ I'd._ lJ <br /> Applicant Complete All Sections Below This Line a w <br /> Permit Types and Fees:(Please,check appropriate boxes) a t <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> /Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> > Accessory Structure(Garage,Shed,etW°1-1rl7 Addition/Alteration to Accessory Structure $150 A <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �� lN7 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o r" Jl, <br /> w <br /> Filling/Grading $150 Boathouse $500 c4 c-",-• <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 tothree times the normal fee. ti <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. 0 <br /> z <br /> 0 <br /> Property Owner's Name: W,Li_,A m1 0YD I o <br /> $L----' <br /> Property Owner's Mailing Address: 535. RE -; t\QA _ i ' ' • 'UIFin <br /> � <br /> � City State Zip E <br /> L <br /> Property Site Address: (o�_ �DR7 I^c{ , �(� IUD is um.- o N <br /> • G <br /> co <br /> Contact's Telephone Number: qsz. -2�5 3 4 I c <br /> 0 <br /> Contact's Email: waJO yd 6.'. MSn . Coln cii <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N - <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and dQ <br /> @BurnettCountyWl.gov a <br /> u. <br /> fA <br /> Legal Description of Property: <br /> Section#: 17 Town#: l{ N Range#: /7 W Town of: UM(0(\I cl, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f"" o <br /> 7 1 I <br /> Ci <br /> Tax ID#(1-5 digit number;found on tax statement): 2.12R j <br /> -3 <br /> Proposed Use of Structure/Addition: SN t L 1 1;iQ R001 /11E j 1� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1- <br /> 0 <br /> �5 <br /> Building Contractor: Sewer Installer: W <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS UB ECT TO ALL CONDITIONS LISTED BELOW: <br /> " �( �1�.✓nc� � f S� D4,-)•�i b J aief <br /> t <br /> 5�� -� -�.�— �l'1 C [ / _ �j �� Fee Rec: <br /> �. p� 6�✓ f P , �/ (�(` o Check#: �1b7 <br /> �'I h m <br /> Y P P z <br /> ° I ._...,ks. <br /> ¢� m r <br /> Date of staff site visit: 7f ieb3 n'tial of sit visi taff: < °' <br /> n a 6— <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:7//etl 23 rrl <br /> <coza <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o C .g w Ind <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w 2 <br /> Pagelof5 rri< a Inn) <br /> Burnett County, WI Land Use Application- Rev 12/2022 0 JW <br /> "-I <br />