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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line C w <br /> Permit Types and Fees:(Please,check appropriate boxes) o <br /> C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 � 1t�. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 -...1 u <br /> O <br /> X. Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> ~ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <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) $100 E. <br /> c <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -o <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> o <br /> Property Owner's Name: \,,/;Li-,Aryl Ley> <br /> 0. <br /> Property Owner's Mailing Address: Z?6535A. t t vtc&, j i ,,DDA)&, y ]J/ 'S i8:7CCs b <br /> v f_ / City State Zip "' <br /> Property Site Address: .Z 6 F5- T u • 1f 1 vca2 1iT 1),,p gi.ir?y iv I sS '30 o <br /> • c <br /> Contact's Telephone Number: %_S.z-z-5 '-•�-5-4/ ._ <br /> a <br /> Contact's Email: a,O ct I o ycl)1►1Sy1; <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ., <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °Q <br /> @BurnettCountyWl.gov I, nn �� f a <br /> Legal Description of Property:4 PRt Sf of O 1 J$.' Ni/2 % '. f 8�•°t- S1 f�TIA/Sed <br /> i ate• 5 9? 5 e.S✓� ex. ^ <br /> Section#: /7 Town#: 4C N Range#: 17 W Town of: L/h lo% 5 SO 1 c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* \ l t---.. ' <br /> 7� *3 p o <br /> Tax 1D#(1-5 digit number;found on tax statement): 24 g8,' <br /> H '1-) <br /> Proposed Use of Structure/Addition: M/AA _S <br /> GC, <br /> .S 4EO r 1 ,t- <br /> Anticipated Start Date: 7/24J2Oz.3 tHome/Cabin;Commercial Business;Bedroom;Deck;etc.) l' ) <br /> O 1' 5 ' <br /> Building Contractor:301Sse,J-S , Wsf JTsiQ 11// _ Sewer Installer: <br /> 'Z w <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> fY1e + c R $ekb4.c is <br /> 3 ifq O$ ( S res (iAps`9. / ? ' /5Ito - oa <br /> (�.i �n1, -{ �/Yf.Ge-4- kit See 6 ill; <br /> Fee Rec:��/ — <br /> Us to ro l��{. o Check#: Ll 7/ 5 <br /> gA<< p l n«ds jv be oil tui4eJ P P b�/ , <br /> I,/ <br /> tr <br /> Date of staff site visit: 7h v 02-3 In'tials f site vis' staff: u E r <br /> m <br /> Q <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/1 1/g3 zIffl <br /> c� <br /> acW IC 0 <br /> m <br /> r < = l� <br /> M cp CD inn <br /> Page l of o y , c inn <br /> Burnett County, WI Land Use Application—Rev 5/2023 c co= ras <br /> la a a <br /> ENrri m <br /> w <br />