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c b <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a I <br /> Applicant Complete All Sections Below This Line ' w <br /> CD i <br /> Permit Types and Fees:(P/ease,check appropriate boxes) - <br /> C7 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 FO <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� ( <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 C <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m' <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. $ <br /> b <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> o IR <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. m <br /> Property Owner's Name: �'rL v�y✓ 14 e- s'e.A/ o _C ' <br /> Property Owner's MailingAddress: j <br /> ' I' <br /> p rty �O. U� y .�Mt'I �1/rLLr _�(�` �k/G�9 c� <br /> City „ State Zip !.. <br /> Property Site Address: 9'3 3 9 T i)w-r, (ltr bi r d nn f) - 6..-4,ry I aI I 91 s ao o c <br /> • <br /> rb <br /> Contact's Telephone Number: 6- So 6 , 9 , a. <br /> %I <br /> d <br /> Contact's Email: f)e iv/ ,v 7i c e 1 i,-c..7i 4 y l© yG,A c:C (•C/^' D <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> o <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and z U° <br /> @BumettCountyWl.gov <br /> P. Zj <br /> Legal Description of Propertyr Nk1ZBi A-VO TO voyAGa viu4=eLoT 'I S �. w <br /> Section#: /5 Town#: (-/0 N N Range#: )5/4) W Town of: 5c,G kS O d 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r79 — o FeTax ID#(1-5 digit number; found on tax statement): ' $4,2.6 cp ; G <br /> Proposed Use of Structure/Addition: HO me. <br /> Anticipated Start Date: (Home/Cain;Comme al Business;Bedroom;Deck;etc.) X <br /> Building Contractor: Sco i 1 W&Ters Sewer Installer: j de Rii,F S ki Ol./1) ` <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> M, - aki s-e.-NOar c-- c11 <br /> •� �rv' ono -}0 2x- 3 bR-d-r°Orns I�-r S -23 -1.3 _ /� <br /> rii el <br /> Fee Rec: / <br /> Check#: 0-4-, <br /> m <br /> v l <br /> Q G yam— m °' Ern <br /> Date of staff site visit: b I 0 /2,013 Initials of site visit staff: 7L I n Cn CD c u�' <br /> CD C <br /> APPROVED BY LAND SERVICES OFFICIA r / DATE: 8`!0/ 013 y z 3 G 0' <br /> UUll <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a `�' Ind <br /> Pagelof5 < ft JJ <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> g <br />