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. i ; <br /> LAND USE PERMIT APPLICATION-Burnett County, WI It <br /> Applicant Complete All Sections Below This Line 5o <br /> ' w <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> III' p <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 C <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 <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 W <br /> all Filling/Grading $150 Boathouse $500 , b <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z <br /> Property Owner's Name: i 6— —VIC <br /> k...1 <br /> Property Owner's Mailing Address: 255) 1:12 S C1/ kP M59c <br /> . n <br /> / ,,, City State Zip <br /> Property Site Address: . f I421 AC A iti'1C <br /> Asa - 37 'gamCD <br /> Contact's Telephone Number: ,ry�J � N d <br /> Contact's Email: , / ,�0 P'-t[ .C-0' / W <br /> Fi <br /> **If staff has a question about this applicatioi1 ou ill be contacted via email. Make sure your email address is N b o4 <br /> legible and your email provider will accept emailsfrom the following addresses: @BurnettCounty.org and o. `� N <br /> @BurnettCountyWI.gov ° (!J .0 <br /> 7 1 of 65m 5'7�& �oL I 35,E g l� N <br /> Legal Description of Property: ! �... a 8 <br /> Section#: /J Town#: 4/0 N Range#: `5 W Town of: nedi5t V — > z„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F — o x <br /> Tax ID#(1-5 digit number;found on tax statement): :?''�'t� ��i��9 � <br /> p FAD i� 1 \k LM� y <br /> Proposed Use of Structure/Addition: �� /�/C Y(`� air- <br /> ►`� �" <br /> Anticipated Start Date: (ye,7-f (Home/C in;Commercial Business;Bedroom;Deck;etc.) 'P g" <br /> Building Contractor: /� 4 Sewer Installer: 9, <br /> z <br /> AREA BELOW THIS LIN FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -Mee-E ct k-{-Poor-s N <br /> -- Li,S•Q ups 101 c o 11A4C6W6 1 f l'Le4) -cl / tro <br /> x Fee Rec. <br /> d Check#: <br /> rri <br /> Date of staff site visit: D/i 7/ Z3 Initials of site visit staff:C ` WO <br /> r APPROVED BY LAND SERVICES OFFICIA DATE: Z 1 2-0(2 3 G° n <br /> g c' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 2 = <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y sc LL151/ <br /> Page 1 of 5 ` <br /> Burnett County,WI Land Use Application —Rev 5/2023 <br /> H <br />