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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0 w <br /> pP mP CO 1 <br /> Permit Types and Fees4'Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rD''' e <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 •I O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> / Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 = .1t� <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. i, <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> 0 <br /> Property Owner's Name: f13r-, 5.A¢p-) '—i,*., ✓ ." _ <br /> E. <br /> Property Owner's Mailing Address: 1�3/ AVE-5Ce7-7 L%i'LS Pe c- -•4iv /IA/ S5%23 w_ r)City State Zip ' kp <br /> �p <br /> Property Site Address: L 7/ /??K S2 e2,q- 6-e. `Tyo.je " o I, <br /> • <br /> Contact's Telephone Number: r/2 ' ,309 .._i'�7 7 a <br /> b.) 2 <br /> Contact's Email: . r t'f"/l-tGsr'. a7o� J-CC?'L` <br /> cb <br /> **If staff has a quest/on about this applicati6n,you will be contacted via email. Make sure your email address is N ,b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and z. <br /> @BurnettCountyWl.gov d <br /> Legal Description j <br /> ion of Property: 0�Srr L f-• -$ 5//cvUi Div of t./6Z(a f'4' c4- c0T 1 3.2. <br /> (� <br /> Section#: 1 1 Town#: E 2-0 N Range#: 1 (c7 W Town of: `/2y D GI la Ili cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F iil <br /> Tax ID#(1-5 digit number;found on tax statement): 14 6 76) 6 <br /> Proposed Use of Structure/Addition: 104,,OE 712 A-su -- -- <br /> Anticipated Start Date: 0— Z..3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ("E <br /> ! (iN <br /> Building Contractor: ,4CCh53 LiF73 Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> d 1 ee-F 4.11 9*bi-ckS <br /> cceSS 4- I/eta,6 <br /> cofie,dvl cctnM' e ci✓ccC 35-�}- 1".�e <br /> fjoilg:- .01 r( , A''e-(Ir 4CCC 5 eXI II `-C e \,e-' c.1 Fee Rec: /C% <br /> 17ecI o.✓l ' co—c co ►J 04 1 1 a3 64 Check#: 7/ 7 <br /> r <br /> &ietku4.4.1s n n�- Pit-ee ,.-9-{- G ���/1 rn <br /> kirn Date of staff site visit:7/i 3l t/ Initials site visit taff: < r ' <br /> APPROVED BY LAND SERVICES OFFICIAL: 6 DATE: 7/?6/d3 (6w co C0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zt. N o M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> Page 1of5 MI <br /> Burnett County,WI Land Use Application—Rev 5/2023 t R. LL _ j <br /> I <br />