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LAND USE PERMIT APPLICATION —Burnett County, WI cn <br /> Applicant Complete All Sections Below This Line 0 w <br /> Perm' ypes and Fees(Please,check appropriate boxes) n d ( '1 <br /> I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Q <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 N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 << '' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ill, <br /> Filling/Grading $150 Boathouse $500 cn ki <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. `� <br /> .0 v .(1 <br /> . <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. o Z' <br /> z <br /> a <br /> Property Owner's Name: 1 (/) f__-.K,. 1 L i , � l. "/ id <br /> p g �(p� ) tP h ,L am-. ta.6�' , <br /> Property Owner's Maili Address: E. <br /> r S t Zip <br /> Property Site Address: ri/l(1� # abM o <br /> Contact's Telephone Number: — — <br /> C7 <br /> Contact's Email: h C7l QY.J C� 6 1<-1 , (mil )2411 7.A) - °- <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the foil ing addresses: @BurnettCounty.org and 0° <br /> @BurnettCountyWl.gov i--©1. f Up r /('4,, $) 75 '1 k d N <br /> Legal Description of Property: ..( �101 / ¢ . torsi,✓lei �� e2 „ , <br /> Section#: Town#: �L) N Range#: / / �.W Town of: .=,e,'c'/ ' K('� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> A <br /> Tax ID#(1-5 digit number;found on tax statement): 3 4 5 7 (uj C <br /> -3 I� W <br /> Proposed Use of Structure/Addit'on: t LC/L.4 — '— '(.e5b,(. R <br /> Anticipated Start Date:lj o,1 1 i 1 o.g (Home/Cabin;,ommercial Busine. Bedroom;Deck;et .) <br /> Building Contractor: A / .. 1 I. `).wer Installer: /(J' z NI <br /> AREA BELOW THIS LINE FOR D SERVIC S STAFF COMMENTS/CONDITI S ONLY <br /> THIS PERMIT IS S CT TO ALL CONDITIONS LISTED BELOW: <br /> 1fee+ aII 5e-I-bc < <br /> a)iiti6f 4( nA h Lb,- ,'°I) ' <br /> Fee Reel <br /> 7 <br /> e Check#:CjQ <br /> rz <br /> r <br /> 0 <br /> ri ' r <br /> Date of staff site visit:(J /(a'3 Initial of sit visit taff: <m —1 , <br /> nz <br /> �7 <br /> APPROVED BY LAND SERVICES OFFICIAL: eveDATE: �/�1 /2 3 Mtn oo u ill <br /> 1 acc 0 <br /> >-, - r— <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i1N <br /> a EMIm e r V o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT cp Q <br /> Page l of 5 Nil <br /> Burnett County,WI Land Use Application—Rev 5/2023 d �� JJ <br /> ro <br />