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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> c <br /> Applicant Complete All Sections Below This Line o' c ta <br /> CD <br /> Permit Types and Fees(Please,check appropriate boxes) 1 <br /> C7 c� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> /Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 aQ O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o i(s <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 .. <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 tothree times the normal fee. ' 3- <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name:6 ��,f�(5 �1�'.fj ,�/d c�5tCCks !�U�r Wi =' o i <br /> Property Owner's Mailing Address: / '"O y yrj71it S(MJ 1Or iL . F,l t u L fl lu ,..5 s /0O <br /> jj City t State Zip ° 4 P <br /> Property Site Address: yS3 D ,4 deth0A-Li / O,,¢ri)7L 9 r l(1: ti i-J .- C� . c !'", <br /> Contact's Telephone Number: t`P /2 —(9 s'a� — 3 (va / a. l <br /> ( j� — d <br /> Contact's Email: �� f)�l / k2 c f .-sf- l �j7f4C-V��J W C-dT✓' W <br /> **If staff has a ques�on about this app ication,you will be contac d via email. Make sure your email address is <br /> N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° °Q = <br /> @BurnettCountyWI.gov b�G -N r1 <br /> q o Q <br /> Legal Description of Property:LOT 1 C SM*22 `(`) V 13 P 17 3 C&Lv LDT4, N 'J <br /> W IN <br /> Section#: �� Town#: ill N Range#: /J W Town of: . 5-(,L%1-'SS vi <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N N o 0 <br /> Tax ID#(1-5 digit number; found on tax statement): (3 /6 , q 5Proposed Use of Structure/Additio : ;S S Jr*. 0 -- / Z,X /6 �'i-i-}vL t. <br /> Anticipated Start Date: f}(43 as-roil 2023 Axis: <br /> Commercial Business;Bedroo ;Deck;etc.) Z <br /> VI cr\ <br /> Building Contractor:C 1-6 Mkk.e,'' .�,1.`I) 5 Sewer Installer: /t,i ,4 <br /> AREA BELOW THIS LINE FOR LD SERVICES STAFF COMMENTS/CON ITIONS ONLY z <br /> THIS PERMIT IS _SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Miuc# cal S -k-kocaS <br /> No4- -C h en i-koh.l a=— <br /> x Fee R5: 1J <br /> o Check#:9-Yc 93 <br /> m <br /> z <br /> v �-, -, <br /> rri <br /> Date of staff site visit: I Initials of site visit staff: /( < r <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: p )i q/An y n <br /> mC C <br /> G< <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o z N 0 N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r o N c <br /> Page l of 5 <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> a <br /> i <br />