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LAND USE PERMIT APPLICATION—Burnett County, WI " r <br /> e. b <br /> Applicant Complete All Sections Below This Line s F (14 <br /> Permit Types and Fees leaase,check appropriate boxes) e <br /> (P� v l <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 c j <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �.Q i o6 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,,J <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 r, <br /> 1%) L--- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures 1l <br /> pg $125 WI State Statute 59.692(ly)Structures $350 <br /> �`; <br /> Filling/Grading $150 Boathouse $500 � <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w -- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. j i <br /> *Communication Towers,Camping Permits&Signs require a different application farm;see corresponding application,and fees. ! `-° <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> ° <br /> Property Owner's Name: - % s S �� <br /> Property Owner's Mailing Address: 1 V° z �C\Y�WAG.0` W� �'� v <br /> ` `� City State Zip r <br /> Property Site Address: �,,.'5 t 4 '` ,AC i 5V v , t •4k,� , \.v1. Ley%c 1 2 <br /> II <br /> Contact's Telephone Number Vt.\A 5‘La ` -1 U i - i ° �I� <br /> L_PriesS ra <br /> .. <br /> Contact's Email: x ' 0 i i�„st ti 4 1 LIANA LC,s • NI Go t'R �g.�. (� i <br /> **If staff has a questio*out this application,you will be contacted via email Make sure your emai�addi ss is N ._ <br /> legible and your email provider will accept emails from the following addresses: 'et--Burnetteounty_org and Si °o <br /> (dBurnettCountyWl.gov ' `� 3 d <br /> LA <br /> Legal Descriptiop of Property: C5� 4*I 9 V i 17 77- o' 1J <br /> Section#: •� b Town#: j 9 N Range#: I ( W Town of: e cnoll <br /> *Attach additional page if needed for lengthy description OR attach a copy o the deed OR attach tar system property page.* i.,...,.... <br /> f 0, o p <br /> Tax ID#(1-5 digit number found on tax statement): )� '; . `� d <br /> Proposed Use of Structure/Addition:., \\&) --i 4 t(A. C)C,s i 6 ki( a , i <br /> Anticipated Start Date: u1 ie('ahmn;Commercial Business;Bedroom;Deck en J l 73 <br /> Building Contractor: S�� . Sewer Installer i C> <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> HIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> P <br /> v hAle ck.1I coAdr49ns vA.R-22.-) £7 V <br /> 3-1-vain we 41, n j �g-6'c)4 ''s re -1r-e ci, Ccs,.,I I/livid its d4 . ` i Fee Rec: w <br /> 6 Check#: <br /> m <br /> //� 7,7 <br /> Date of staff site visit: �(I 17123 i ' staff': NG!� 0 r- �J <br /> co o- <br /> / <br /> 0f/7d- m APPROVED BY LAND SERVICES OFFICIAL: DATE: "'cocoC 0 <br /> e . <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o y 0 <br /> g o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page 1 of 5 < a iffl <br /> Burnett County,WI Land Use Application—Rev 5/2023 d J� <br />