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• <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a cw <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> d 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> ,)( Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p(� a <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , `C <br /> C) u1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 v" <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 • <br /> A b <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ‘.5 4 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. ro IS <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b .. <br /> z <br /> 0 <br /> Property Owner's Name: NY A N__v s o 7 D O r(nt A M re A!s o o <br /> Property Owner's Mailing Address: <br /> G! 03 Co.,vey 11owaX we$srFr. UJt Shl S era 7 lb <br /> City State Zip E <br /> Property Site Address: %Au E < <br /> o e2 <br /> • c <br /> Contact's Telephone Number: G� 1 I.- 1.8 0_g 3 6,, c. <br /> . <br /> Contact's Email: Sit'p 'r.yso,'t 8@ at M Pr/t. , co1 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b 6 <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and S °Q b <br /> • <br /> @BumettCountyWI.gov c ao <br /> g 1, <br /> Legal Description of Property: S Ea I l Tht .3 cif 72,es 16 ( /Off S C 74 u. L Or S of C;'N k. `. <br /> Section#: 13 Town#: 31 N Range#:46•)(0p`W Town of: Ni ea t4 D <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F <br /> Tax ID#(1-5 digit number;found on tax statement): j, 1 '4 'L,S W o d <br /> y 1 <br /> Proposed Use of Structure/Addition: ?A n L.L. F411-v 1.E A i1.A t <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C 1V <br /> Building Contractor: Sewer Installer: <br /> z G <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xi S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> .1\61-4 C.W. re.�x1 S <br /> o - - V\C 9i - ''\ / <br /> z Fee Rec: <br /> " 1 Q r13 S -'D b e. K( n -F--ec( W rim e I by �1 i�'J2 0Zy 4 Check#Cr y <br /> m <br /> z <br /> o <br /> Date of staff site visit: ;''i 5/202-3 Initials of site vi 't staff: /` t < r <br /> APPROVED BY LAND SERVICES OFFICIALG ATE:RI aIZOZ3 W T <br /> °C' r- C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 2 o — N <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT vr. CD <br /> Page 1 of 5 m N Burnett County, WI Land Use Application—Rev 3/2023 0 L(..,.. J� <br /> a <br /> K <br />