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. i <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 5' w <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) d <br /> w ,�T <br /> X. Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 QQ p <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 <br /> Filling/Grading $150 Boathouse $500 <br /> w <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. ? -. <br /> z <br /> Property Owner's Name: � ? ) 1 ��_[ <br /> Property Owner's Mailing Address: 65115 - 2 'T /3s,, i\I l 5 --1 , 1N 55(Y) . n <br /> Q—A <br /> City State Zip (1 <br /> Property Site Address: Z N.,'7 let ,�v' -k� -ter,_ Q—l'A ti <br /> Contact's Telephone Number: 65. 1 -- -31,,-O 41 Low `� <br /> d <br /> Contact's Email: OA 1/4.)._4--0.-4Jr.LIoL.t j .J' C . (D,->-- c\ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro r_ <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and P. <br /> °O <br /> @BurnettCountyWl.gov <br /> o <br /> Legal Description of Property: \I(A) '/t-I p N Ey , <br /> Section#: 20 Town#: 40 N Range#: 14 W Town of: `j e o i- t- (/) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* x <br /> C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 1 `�2-%1 <br /> y <br /> Proposed Use of Structure/Add'tion: QD( — \DC,_,r- n M-e, <br /> Anticipated Start Date: tt I p2, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t <br /> O0 <br /> Building Contractor: `LG.v e-C,---'c— Mf c-tJ 5 Sewer Installer: 'u A A c;�`t-.,c,Ly-r1 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS SUBJ CT TO ALL CONDITIONS LISTED BELOW: <br /> gMee+- c1,1I 5efha <br /> pvve,lib 401- dv exo4o1 3 bec60/445 e-e-(540-d3-/56 <br /> Fee Rec:�( � <br /> d Check#: ' 3 , <br /> rn <br /> r- <br /> /� m r <br /> Date of staff site visit: 7b �23 ti is • a visit staff: �.i co <br /> / � cpW C <br /> APPROVED BY LAND SERVICES OFFICIALlitre <br /> (55 <br /> DATE: ��a f j r 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zoo EU <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w <br /> Ififil <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 5/2023 y LL J9 <br /> a <br /> 3 <br /> 13 <br />