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r <br /> LAND USE PERMIT APPLICATION—Burnett Counter, WI 2 <br /> Applicant Complete All Sections Below This Line -�� w <br /> Permit Types and Fees:(Piease,check appropriate boxe II- <br /> - e <br /> Dwelling/Principal Structure ,300 Addition/Alteration to Dwelling/Principal Structure $200 ,,r, <br /> ,Commercial/Industrial Structure S300 Addition/Alteration to Commercial/Industrial Structure $200 `i 1,� <br /> Accessory Structure(Garage,Shed,etc.) t€ S).50Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) 200 (addition/Alteration to Bunkhouse $150 y \;� <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 I <br /> v: <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 to three times the normal fee. `,-: <br /> I .9 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> l*Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 o <br /> Property Owner's Name: j �,�n _ o '� (� <br /> -.ALIT'G Yee __._--._.. -- i4 <br /> Property Owner's Mailing Address: 2,0_1(j 0 Vli' L�[,�- W1 5 4 I, l <br /> 1 - <br /> City State Zip/� r --ci <br /> Property Site Address: 237O5 0 LI) _3 _ _- s-i _-_.-1�J.-I._._5 C1�Z `l - <br /> Contact's Telephone Number: 7/S --5-91 ` 3&3� <br /> IS N <br /> T <br /> V U <br /> Contact's Email: e-ar4-7 0 ',Ye Cetni_ _ __ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is I� <br /> legible and your email provider will accept emails from the following addresses: ;cgBurnettCounty.org and "° V <br /> ta)BumettCountyWl.gov cr. 19,, 7-- <br /> Legal Description of Pro e /nk2 o I- Z G.im r 7 P 2-39 Co yct�l°I z � <br /> P P rh' - — — - <br /> Section#: I IP Town#: -3g N Range#: L_I- IA Town of: 174,t d S __--_ 1� I <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systenr property page.* ,� o p' <br /> Tax ID#(1-5 digit number;found on tax statement):_ Z2-Z ( IFc� ` <br /> Proposed Use of Structure/Addition: tTOflL 1 N <br /> P <br /> Anticipated Start Date: ArP (Home Cabin:Comm,r r,i i usuve,e:Bedroom:Dect'etc 1 ek, <br /> Building Contractor: hide12 �f(��j�('��e___��C.e� Sewer Installer: <br /> 7_ ru <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> BELOW: <br /> THIS PERMIT IS SUBJECT TO ALL t- OM)ITICN i LISTfl) <br /> ree, a1 544,1 _ 3 _ 69 <br /> ,eCl,Y lief 4 C(ee� ; b• � Per SHIN <br /> '%� <br /> ISO D r V a/1 a 17ce �i PVpCj' V U ! Fee Rec: ( - <br /> ��i cabs,,,,%cabs,,,, ' f <br /> J Check rl: <br /> 8 S/z.11 <br /> = r <br /> Date of staff site visit: (/Q/l7/3-3 Lit'al. of site v., it staff: / _-_ J <br /> Inni <br /> APPROVED BY LAND SERVICES OFFICIAL: I . , nATF:(�/LB/?- `. . <br /> UPON APPROVAL: A.PPLICA N T MUST POST COPY OF <br /> •tt). <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c <br /> Page l of 5 • <br /> �- <br /> Ina <br /> Burnett County, WI Land Ilse Application —Rev 5/2023 a ' <br />