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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> 1; 2 <br /> • <br /> Applicant Complete All Sections Below This Line , ce <br /> 0. <br /> Permit Types and Fees:(P/ease,check appropriate boxes) . <br /> d <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 rrD <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' % <br /> Filling/Grading $150 Boathouse $500 T ~ <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> 0 1 <br /> Property Owner's Name: GA Ry Oral l We . <br /> o <br /> Property Owner's Mailing Address: 9253 W. f p A 12K, Sr DMAlB 1ti.y WI 5+630 n �, <br /> City State Zip ° c <br /> Property Site Address: SAME • o <br /> / <br /> Contact's Telephone Number: 6S '" a10 - 31-/� CD 1 ( a <br /> Contact's Email: <br /> 9 l'fc ( � v�na l' I . Co w1 d <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and o °Q <br /> @BurnettCountyWl.gov oz <br /> Legal Description of Property: pa rti� oc(a s i- Gt. to`i.2 wMf (b awes o4 ea-St•to acke S E..Le <br /> g pGov t jot one <br /> Section#: 2 S Town#: 40 N Range#: t 4 W Town of: V N I 0 N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o A <br /> Tax ID#(1-5 digit number;found on tax statement): 250 S4 C <br /> y <br /> Proposed Use of Structure/Addition: OUTd00( 2-SEA$oN COVERED A-RCA <br /> Anticipated Start Date: c1/ I /20z.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ^ V l <br /> Building Contractor: SELF Sewer Installer: Nlf} • <br /> z b --r__ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> @Iee k a�� S�T�u5 f T <br /> ®p�,�11. �* -}a gcCeth 3 bec601415 per 50v 24793 <br /> aLoCi'l { .n ,s ii e-ec on 5 e ' f� 1, 12 �l)3 <br /> x Fee Rec: / <br /> o Check#: 8714/ <br /> m <br /> z <br /> v <br /> It <br /> Date of staff site visit: 7/a51?-___3Initia s of si a v' it staff: p)-tf -/ e c_____,.......___, <br /> ) ,==, <br /> / n ,- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/�/a 3 m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o Z 5 F- 0 <br /> z F., CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ m N o <br /> � = <br /> Page l of 5 < � ' <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 et Fill <br /> D.-3 <br /> 3 • <br />