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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 5. NiCD <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> C7 tS,-- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 GZ r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk le Bunkhouse $250 ' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 p <br /> Filling/Grading $150— Boathouse $500 lib <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 w <br /> 5' <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o , <br /> z <br /> 0 110 <br /> Property Owner's Name: ' a) "P. L-,tJt {(JLe\ o <br /> Property Owner's Mailing Address: I lID tAl k(ry 1 AVE- '$Iammkt /-(N 53-1( <br /> Q n City pState Zip ° \ <br /> Property Site Address: /��( (J��G L im�b , /` Ue, �/ 9G30 o <br /> Contact's Telephone Number: 6tp2 yO 3 o32 — d <br /> Contact's Email: Z.IcN• C lP /O L - COt\ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N 'o —fl <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and (To <br /> @BuniettCountyWl.gov gro <br /> Legal Description of Property: IU 0- 6G.) GY/ NLY IF kkAr ®F C.0,064 ea 5. <br /> Section#: D Town#: ifv N Range#: /11 W Town of: _56 D 7-7 <br /> o <br /> *Attach additional page if needed fbr lengthy description OR attach a copy of the deed OR attach tax system property page.* W <br /> t-,- '5 ) <br /> a b <br /> Tax ID#(1-5 digit number;found on tax statement): / 7-9--/ I <br /> Proposed Use of Structure/Addition: 3 �L �' d <br /> Anticipated Start Date: aiit( (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) ,t_, — <br /> eA-8�� -- <br /> Building Contractor3jAv A � �C1X YC XREI(Sewer Installer: lJ//k <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> .-4.Ioo S s <br /> • No 'l v!-kt.n cir 17 ,,odlia) cuwo 't,,\ = <br /> a,0. .imiL ,� nd -F bu.voteuk. <br /> QJ- -_ .,, ,, <br /> Fee Rec: <br /> E/ui 1�-�r W flc - X.c Q-c� ,yOD7Y� c" Check#: ` j <br /> •UitIol1 euaka.sc Ct) vj}- <br /> Ve <br /> z <br /> 0 <br /> �/2y 12-OZZ �` xDate of staff site visit: Initials of site visit staff: < <br /> APPROVED BY LAND SERVICES OFFICIAL��(/,(,�,1,1 Q DATE: C/A/XIS rn 0 , + <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o - „ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m o S C <br /> Pagelof5 < (....' 1l( <br /> Burnett County, WI Land Use Application —Rev 5/2023 d a ' <br /> a L . <br />