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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> Applicant Complete All Sections Below This Line 5 co w <br /> Permit Types and Fees:(Please,check appropriate boxes) ° 1 <br /> a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 g <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> •Y <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 cC `t <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r 1 <br /> Filling/Grading $150 Boathouse $500 iiii <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 to three 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 /> 0 <br /> Property Owner's Name:Ye ntO n a LCu1i 1-ct 7- h -c n h©tC -en l5 tN <br /> 3u/31 19 th Av-e W' Neu.11O4O m b <br /> Property Owner's Mailing Address: {� w n <br /> Property Site Address: 0�2 CO 1,1Y1")-t� 1�Gq • O � Q S- �rCity State Zip�j(1+� C y <br /> ✓✓✓✓ c III <br /> 32O-405-- 1.o361k N a • <br /> Contact's Telephone Number: c , <br /> Contact's Email:4W ntOnht C b+C nria <br /> 1 P n 0 9 a r l©o•(o m <br /> **If staff has a question about this application,you will be ontacted via mail. Make sure your email address is N - <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and 8 ao <br /> @BurnettCountyWI.gov o N <br /> 1 q r P <br /> Legal Description of Property:to 7 of c-e Y}4tj f cl map.*5`g1 ,vo 1, 2t), Pl j •2 f-7 d 21 c- 5. -J <br /> Section#: 1 CI Town#: ?j N Range#: 1 1) W Town of: =44e49§4a'1I"fli een O n r„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* U' F x <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> 3to210 7 <br /> Proposed Use of Structure/Addition: Start i f CO n I n ev w N <br /> Anticipated Start Date: novel n azt 'wL Home/Cabin;Commercial Business;Bedroom;Deck;etc.) --O <br /> Building Contractor: n 1 01 Sewer Installer: n I a • 0 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Ju+ "Rl! Lynam( i ""' Fee Rec:/ <br /> 5 Check#: 4=4.6) <br /> tv <br /> 0 <br /> �Date of staff site visit: I I 1 2,02—'5 n' ials of site isit staff: <br /> r <br /> rz a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: . m co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z RIP--, Ira <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , 0= N o <br /> Page 1 of 5 w' <br /> T1-.-.--•-•I'T.----s.-. VT TT T _---1 TT_.. ♦---1:....L:-- Tl..-.ONA^1'1 7 <br />