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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> cr <br /> a g <br /> Applicant Complete All Sections Below This Line 0 64 w <br /> Permit Types and Fees:(Please,check appropriate boxes) Cl <br /> 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 \�O <br /> i< Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 5 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> P <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < k) , <br /> Driveways/&Campground Structures _$125, WI State Statute 59.692(1v)Structures $350 o V/ <br /> Filling/Grading $150 Boathouse $500 <br /> uz <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 tothree 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 /> ° <br /> Property Owner's Name: WI I cl�,ke I r v:li� cj C In tk r p i nq o N - ! <br /> a. <br /> Property Owner's Mailing Address: 3 c `i W e St 5 hang r,Glc- �JJi v . 4-r I i not-ty, i1I 55 3e 7 N <br /> City J State Zip 6 cn `C <br /> Property Site Address: 3 1 I 0 C+t k� VU ztOS r I. 9 3 o N 1 <br /> Contact's Telephone Number: 5-0 7- 3 1 -7- a(p'-f I C i v t i ke-) N n. 1 <br /> d <br /> Contact's Email: °`r P 'n r C ,► A 9 —1 9 6 � �cGtvv :4 ( , C c, t CD �, <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N J <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and ° °Q 1�v �' <br /> @BurnettCountyWl.gov L N -� <br /> Legal Description of Property: F-I O WIe, I C u.b;n 5 <br /> Section#: a Li I Town#: 4 0 N Range#: IT W Town ` N <br /> g of: �Cl�!kJGYt � o) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W ,-.3 <br /> Tax ID#(1-5 digit number; found on tax statement): 3 y $h'Y <br /> W <br /> Proposed Use of Structure/Addition: G&r a e. --c <br /> Anticipated Start Date: 5,e of _O a 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) "'C i C <br /> ,1 t Building Contractor: 1 )c{er kk,u p k, _ I n oiSt. Sewer Installer: 3 GZ(:k StY' I'i IAV"tk2 icJ f H}J� "� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •MtkA- CO sejr c ckS <br /> Nam}- 40 6e_ used -40r lquovIA It iA-a,+i n v <br /> ld <br /> • lye XZ9 ' $-Ivrav Sheet g1AA 12' X Ilog fcan Reeds a LQftd u.Se Perrni-F .i Fee Rect/S� <br /> o <br /> Check#: '7 7 )i <br /> C(,lcl:eSSprf S-h -lwe �o.� . 12 i 120 Z3 0, <br /> z <br /> Date of staff site visit: ClI27 /2013 Initials of site visit staff: T n , 41 <br /> APPROVED BY LAND SERVICES OFFICIALKf1 ATE: c6/27/2iz3 ` —mb U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF : <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .:I N <br /> Page 1 of 5 <br /> Burnett County, WI Land Use Application—Rev 3/2023 - --,-- - <br /> cn <br /> -3 <br /> a <br /> s: <br />