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LAND USE PERMIT APPLICATION—Burnett County, WI g �� <br /> Applicant Complete All Sections Below This Line b' ca <br /> . ' <br /> Permit Types and FeesPlease,check appropriate boxes): a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200cif <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) tsYSb Addition/Alteration to Accessory Structure $150 4 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 .- i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 Ci. g Driveways/ <br /> &Campground Structures C <br /> Pg $125 WI State Statute 59.692(ly)Structures $350 S' P _. <br /> Filling/Grading $150 Boathouse $500 W <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once).___$100 F4.. <br /> ■r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. b <br /> quire a ' eren appication orm;see correspon n ,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> I— o <br /> Property Owner's Name: NQ,-1itjLM1 / -a. m D x�4 <br /> Property Owner's Mailing Address: 035 /D l- Air Q. 1 ed rep* outi 5 S 0' <br /> f _ 4C,- E <br /> Property Site Address: a`a'0 g S 7� _ Rio 70 f DOlr1Q.Y1Ty £01 6ty t<O) o 0 <br /> Contact's Telephone Number: (051 155 gq (3 ri. <br /> yw c.9 w^U' <br /> Contact's Email: P 1t( ( y1.S}' (L. )OY1 g /ni.Q� . am .". <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ,LI <br /> legible and your email provider will accept mails from the following addresses:®BurnettCounty.org and g. <br /> @BurnettCountyWL.gov <br /> O H._Legal Description of Property: 5. <br /> Section#: S 3 Town#: 3q N Range#: ( t"'� W Town of: R�k <br /> r4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ti\I V <br /> ,�Tax ID#(1-5 digit number;found on tax statement): I (033'1 16033E y <br /> Proposed Use of Structure/Addition: Porketat tttn - <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:Pro_ n ter Pal la/0 �. I t $ Sewer Installer: NI A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - t -4- ci L1 SeMbaLIS I <br /> ek ( 11,V.314O41 hkrittkal . - Fee Rec: _ <br /> UCC ( (61: itee 4.ed -CV( -{i cario cc ak tw bgt I30 ti Check#:I z3. LU67 <br /> •(Art sari5t-it.kcjvcv..5 34160 euc i' E <br /> Date of staff site visit: r 1 1 2 123 Initials of site visit staff? 1 1 r r <br /> m <br /> APPROVED BY LAND SERVICES OFFIC /DATE: I 17 f'2i73 . .re ,_ 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o { <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT i <br /> WCZ <br /> Page l of 5 3� �' c <br /> Burnett County, WI Land Use Application—Rev 3/2023 8 R V <br /> '' 11 <br /> E <br /> ro <br />