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LAND USE PERMIT APPLICATION — Burnett County, WI c r <br /> s <br /> Applicant Complete All Sections Below This Line 0 c w <br /> Permit Types and Fees:(Please,check appropriate boxes) a <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 Co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 !--- <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 5Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> V <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> i <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E. - <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. & 6 <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. V <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1' <br /> o <br /> Property Owner's Name: IVO t e. m r 0 P.c4 I$ , 1_I,..C. ' <br /> Property Owner's Mailing Address: ? Ut —60. (p ID rl hft 1 � . <br /> �� --City to Zip ° c `, <br /> Property Site Address: '29 '2 2 1 4o er t,, kke. R b k o <br /> Contact's Telephone Number: fl I1 2,Oi-f�- 404 gy a <br /> d <br /> Contact's Email: V eil f ,�a, No(4--�5\Q.ac p �('(� 1'1iC$,C�1 rv. . <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N V <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and on <br /> @BurnettCountyWl.gov 1 \01 <br /> d <br /> Legal Description of Property: S iV S j 'L 5 d-55��)t �J -r.h., C PCL i^C e 18 O-?93) �. <br /> Section#: 5 Town#: LQV N Range#: J 6, W Town of: O,k la/ d .5t) N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O o <br /> S� v_ <br /> Tax ID#(1-5 digit number; found on tax statement): 390. b <br /> � y W <br /> - <br /> Proposed Use of Structure/Addition: �Je Ck h 1 e A <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c(\ ••- .. <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> OinGef Ail <br /> I t/04- 6( 1i.,41-.,n ititOav4)o') <br /> 3 OCC IVA- Je ekee41 ?. 5 � <br /> e8 " �,`' <br /> x Fee Rec: <br /> la v Check#: "7,0Q1 <br /> m <br /> Date of staff site visit: R 124/?3 Initials of site visi staff: wh 4-11I tt< a <br /> e�� F co m <br /> APPROVED BY LAND SERVICES OFFICIALLY DATE: 9 1 7f5 ma, - 0 <br /> cl co <br /> inni <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o a ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> a ITN <br /> Page l of 5 <br /> Burnett County, WI Land Use Application-Rev 3/2023 y �� <br /> a <br /> i <br />