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• LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a <br /> Applicant Complete All Sections Below This Line G w <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> a. <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cD <br /> Commercial/Industrial Structure ,$300 Addition/Alteration to Commercial/Industrial Structure $200 D O <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ; - <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalkd< <br /> Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> .k., r ' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. 4 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> p ; <br /> Property Owner's Name: Do 0 LA-Jet Id '� <br /> �J r 1 S$U9 La.r z I `�c "/ 'r's y z r E. <br /> ' <br /> Property Owner's Mailing Address: `-��� ' New l foA�1'�9 Al d <br /> City State 1 Zip ° n <br /> Property Site Address: 65-02- ad.v. is I q k rc.\ <br /> O F <br /> Contact's Telephone Number: 7(`u 3 -- 4-1,-0- $ i L 2_ o <br /> d k wa i 4 . d <br /> Contact's Email: O y • <M 4 r ( � Low-) Fi <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and V 04 <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: t...e..ri— I C V3 ai <br /> Section#: 2 6 Town#: 40 <br /> N Range#: ) ( , W Town of: da 4 l 4 iL J <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 36q2- <br /> Proposed Use of Structure/Addition: S'e4, Occ,.k ( tea ivTa/ W <br /> Anticipated Start Date: (Home/Cab,;Commercial Business;Bedroom;Deck;etc.) . <br /> Building Contractor: Sewer Installer: 14 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: .h..ti <br /> d Meee4- 4, 11 5e4'b s <br /> a NO4- r kiuinv bilnrl f11 <br /> r <br /> ,'o✓� viol- I d} b. s1 c,3 ,,n-- "e 'Q5"oc <br /> 051teel d ?D �C �!`�w Fee Rec:?S <br /> , - it, r'1cro'•s- flal 674-C,finQACC.- o Check#: )`t'j Sri <br /> m <br /> q <br /> Date of staff site visit: /I ` /�� I 1'tials 'f sit isit aff: liE C� <br /> RI <br /> APPROVED BY LAND SERVICES OFFICIAL: // DATE: I /?I/2 3 7 <br /> a pi 0 <br /> > m co iv <br /> � < 3 "Ci <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . = r C <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 r;::: <br /> a <br /> 3 <br />