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r <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 7 w <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> d <br /> Dwelling/Principal Structure $300 > dition)Alterati% to Dwellin: Principal Structure $200 n <br /> Ad <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150C <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 W" (1:: <br /> Filling/Grading $150 Boathouse $500 v) it <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 gS <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 9*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 2. ' IV <br /> o <br /> Property Owner's Name: j cJ RI- 4 P R M e L A d t-5 o rI =' <br /> Property Owner's Mailing Address: (�q( N l L LTo P R D) SO ELL_ LAKE W I 5-9$7( r \ <br /> ,, City State Zip E S <br /> Property Site Address: shmt2 AS AY3nvi c <br /> Contact's Telephone Number: 7 15- ' ea V- 7-2 8 7 Q <br /> Contact's Email: 52 3.1.5.A _ t Close • cdwx <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °0 <br /> @BurnettCountyWI.gov <br /> d <br /> 7 <br /> Legal Description of Property: S E s E 5. <br /> Section#: 3 5 Town#: 3 5I N Range#: tit W Town of: DEw EY C„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* <br /> „ . <br /> Tax ID#(1-5 digit number;found on tax statement): 3 co l!o d <br /> W <br /> Proposed Use of Structure/Addition: £3(ZEE Z>:-WAY I ETW ECN /J&ry GA RACE A Nib I4OU.SS <br /> Anticipated Start Date: s uMrkr-cz yo 23 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 19 ' 1 <br /> Building Contractor: ni C.EtAp e c I p Ep�1 E�zFk c`v, Sewer Installer: N/A P -N <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,� <br /> I /v WI- 11 5- EbAcLs <br /> e.well,' (14. -If) 1 aclre�,.se__ i/ <br /> 0660j-iv! t -b be seivic ei7( ara (etacl / 0 l ia-`1 g, Fee Rec:II C) <br /> Check#:112.2`1 <br /> r- <br /> Date of staff site visit/ 8!�3 Init'a of site vi it staff: OF 5, m <br /> FM c4 <br /> APPROVED BY LAND SERVICES OFFICIAL: g DATE: 3 v' v' <br /> cp C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . o� o � <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> Burnett County, WI Land Use Application-Rev 5/2023 Iv J� <br /> H <br />