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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> N. .- 1 <br /> Applicant Complete All Sections Below This Line CD w <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) 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 F1-1 <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0Filling/Grading $150 Boathouse $500 v) <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 /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g r+ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> z <br /> a <br /> Property Owner's Name: Do u 3 \,j at Id <br /> o <br /> Property Owner's Mailing Address: 5507 C..ctu eJ t a v e- N. N e.w I4ceC... /2-7/✓ £3 1 ZF w <br /> (v <br /> / 1 City State Zip ° �' <br /> Property Site Address: 5O Z De V,' (S ( u ke rd. w e.bsrerr W 1 51:4 fca - <br /> Contact's Telephone Number: 763 - LI H 7- S q 6 2- 1r..... <br /> CD <br /> a_W t7 <br /> Contact's Email: .1 a U.,° �ci 14 e GM q I • c' oFt <br /> **If staff has a question about-t'fus application,you will be contacted via email. Make sure your email address is N ,9 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° 00 <br /> @BurnettCountyWLgov n <br /> Legal Descriptionl! of Property:L� I C 5j/14 V F, 3 K. <br /> Section#: �O Town#: 110 N Range#: l 4 W Town of: C A Icm/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Y ) o '- <br /> N <br /> ) <br /> Tax ID#(1-5 digit number;found on tax statement): 13 6lG a 6' 6' <br /> Proposed Use of Structure/Addition: Ca t Po er Pc.) ,C P Oc r J t'u N <br /> Anticipated Start Date: 10`_ 15 20'2_3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O #s <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: T� <br /> AL.+ Mee* Atli SC-Fhetc- 5 <br /> & lipc,U -I dux:A t <br /> WA- -,r k m n �1-ko4 a✓l se c t <br /> lolk1?' S ,sly a �► ae ' 1? 1�?" -� -I�k........ <br /> 'I_ x Fee Rec: <br /> irloiv Use peatiats 4 v I �4- a A s elVec c n Check#: <br /> I ✓ i 1 ved w.4 me - Coy,. rz <br /> Orrivi3.04 155vts be <br /> Co/1 Scrva4b/� / 4wrc(4 We er r z <br /> rn <br /> Date of staff site visit: �/2-el/2- 3 Initials site vis. staff: /". rn <br /> <ri j r <br /> Q/ f a gl <br /> APPROVED BY LAND SERVICES OFFICIAL: `[J�►� �f DATE: 8' 3/!2 m�° <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o Nc_n rrI <br /> -zt v 0c t.,a u� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 , <br /> 1 �it sitte D& n )avid' 'J e Pe-14 4— Page 1 of 5 m (-(1 <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 �L , <br />