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LAND USE PERMIT APPLICATION -Burnett County, WI a r <br /> Applicant Complete All Sections Below This Line 0' ' ca <br /> Permit Types and Fees:(Please,check appropriate boxes) ;at <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 °; .W-t <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 'Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N. 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 \ <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 f. <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g. <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. a <br /> g. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o �. <br /> Property Owner's Name: 'TO/"' '1'1 <br /> °o W <br /> Property Owner's Mailing Address: 1 /7 1\ Li .ter` `; c c <<� c) f"L 5 r V'\ S`�el c,w n J <br /> p 2 City State Zip U1 <br /> Property Site Address:o 3 Pa(k S-1L• 16c.)—n. us-ti < <br /> r r O G ft, <br /> Contact's Telephone Number: 7 /J 2. t/�1 r� 7 3 ( a <br /> 1` i d <br /> Contact's Email: G 0 &� . 1 t-,;,, 1 u,\ /+(c, 1 -Lor`" :% <br /> **If staff has a question about this application,yoeu will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °Q <br /> @BurnettCountyWI.gov ao <br /> E'NSENNIS LPr451-1D2e ` 1V OF ‘iEL.I ' LAKE d <br /> Legal Description of Property:LoT 19 4 20 RLk I O 5'. <br /> Section#: l LA Town#: ki 0 Range#: k-L' W Town of: 0,-,_lel L IA r` 4-\ Cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ._! - o <br /> I Lt C " <br /> Tax ID#(1-5 digit number;found on tax statement): p d <br /> �73 <br /> Proposed Use of Structure/Addition: <br /> � � S <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,--1 <br /> O U`) <br /> Building Contractor: Sewer Installer: 6_ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Nl ..+ O. C c»,.n+1 v eetu;A : -eytts <br /> • D n ly oalowt d -Eo ire,p 1O,c-& 17 t X [D' S"rw- { l`l -e3G ✓1 7 <br /> -c rime+ Che kec#: 5j-S <br /> o <br /> m <br /> z <br /> ° -1 <br /> m it <br /> Date of staff site visit: /3 2t-3 Initials of site visit staff: <br /> g Kg E <br /> APPROVED BY LAND SERVICES OFFICIAL / DATE: 'il 5/2t25 MCV <br /> a CV = a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z PM <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT A Q CO z <br /> Page l of 5 a <br /> Burnett County, WI Land Use Application— Rev 3/2023 0 Fr-z- <br /> a <br /> - <br />