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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line CD w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) ° <br /> G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `-.j O <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ti <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 I <br /> vz <br /> II,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. <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. <br /> z <br /> Property Owner's Name: Az f-a-vvx y beL 4 r~ .T' ,� o <br /> ' <br /> o <br /> Property Owner's Mailing Address: 6 74V gL'�bc a Clr. `�r 'Iiior 6'-�. 1-s: YN''t/ 55Z'71 v <br /> // 5 City State Zip k) <br /> Property Site Address: 3 y�b l—QL'O0 LC.Lc. Rot bil I L..r y VaT <br /> o c <br /> Contact's Telephone Number: t2c 1 — a VI— %o 3-7 d <br /> Contact's Email: ID 6 4 r .0 r � y S '11 � G 4 a 0 ° ( o r-n CD**If staff has a question about this application,yo6 will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and S °° <br /> @BurnettCountyWl.gov a <br /> Legal Description of Property: )'b 1 of )" CC A bra✓l d S d <br /> . <br /> Section#: 0 \ Town#: go N Range#: 1 S W Town of: A C k S O r- '1'*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CDo <br /> Tax ID#(1-5 digit number; found on tax statement): ( g 1 3 <br /> Proposed Use of Structure/Addition: (.c yyk p 2 r ( c. -° keel <br /> Anticipated Start Date: .1.-4-1) -0 4-3 (Home/Cabin;Commerci51 Business;Bedroom;Deck;etc.) . <br /> C? �Building Contractor: ✓yte. Sewer Installer: W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> — .+ au <br /> — No* -roc h u yttx_y, lAu ao i-f-w o <br /> 4 x Fee Rec: � <br /> v cav2. kr Parc_eL (TI Ir TVAe S ti c � <br /> r o Check#: (c 5 <br /> _C ; �.eXm,.4_ °� 'esL. -4-° 6-( y I i ZoZLI , ►f frceAU. m <br /> m 1 1. J <br /> Date of staff site visit: 27 2,3 Initials of site visi staff4ir2 <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: 7 g1/2123 ao C 0 <br /> x 3 r— <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . - lnN <br /> O <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT J <br /> Pagel of 5 (N <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> i <br />