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I 2 <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees(Please,check appropriate boxes) ° <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ^, <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 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <° , <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0hi <br /> Filling/Grading $150 Boathouse $500 <br /> a7 <br /> rD <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. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S ^' <br /> o <br /> •Property Owner's Name: •k-li�,o Ire ibis= �'"Lt,,,at(.c cz�*'" tI a <br /> Property Owner's Mailing Address: �3`2 ) xi > >( -RRe` If Off (. 4. Cj 9-Q%� d c <br /> (� City I State Zip E ' ;r <br /> Property Site Address: `?s 1 to c..t,g r- t, I, - < <br /> i ° y ,.., <br /> • a <br /> Contact's Telephone Number: (,. .,(0— 2o'S-Elci P.,1 .. <br /> Contact's Email: `j A_WC L.J. >� -1'1 ti t tZ' 1D pi,, Leta r.v , ('.,i, `'1, t , <br /> **If staff has a question abou4 this application,you will be contacted via email. Make sure your email address is N ,ti O <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and E oz 1 <br /> @BumettCountyWl.gov .� '� <br /> Legal Description of Property: Leo i S M v l C.....3(4/3 V A P( O t 7 `zbq 7 - i R. ...I <br /> 0 <br /> Section#: 1.')-) Town#: `-1 1 N Range#: k () W Town of: L,p:SC.) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 5 <br /> Tax ID#(1-5 digit number; found on tax statement): 7 '-'1`'t d <br /> .-3 VC W <br /> Proposed Use of Structure/Addition: 0 t:) k i L2�• 6� <br /> Anticipated Start Date: t�vt . V-O '- (Homi/Cabin;Commercial Business;Bedroom;Deck;etc) ,.t ' O <br /> - a <br /> Building Contractor: CD e`� 1-Sewer Installer: �` 6 p\e i 1-<<j z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 01h.e.e - A lI 5eI k5 r <br /> ®San,v s s4cres ✓1 us4 sep r� ail I I o,1 P ecc I -{4- <br /> u�� I L 5 �..�!�d gd d.err.,4f- <br /> 44,.e. qwe/i , }- 55e(Vicc) i5 04 I� 1 <br /> P � Fee Rec: <br /> �]�, I le 101 PD �C s47 '- I v Check#: f�33g <br /> ihjelfc55 <br /> QeNL, 1�/ � � � m'w 1�,�, i- 1�/1 23z <br /> t 5 n �° o <br /> rn <br /> Date of staff site visit: 7 )0 23 it'als f sit 's' staff:H / < ry <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 9(a/ '?3 y m <br /> > <,3 '— <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z y w <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ..< a N <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 v �L J) <br />