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i 32g0y <br /> 43 200' LAND USE PERM'T APPLICATION —Burnett County, WI a rn g b <br /> ' tJ <br /> Applicant Complete All Sections Below This Line 6 `; <br /> Permit Types and Fees(Please,check appropriate boxes) �. <br /> Dwelling/Principal Structure $300 K Addition/Alteration to Dwelling/Principal Structure $200 P. 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> S <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 A <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 F <br /> a <br /> $250 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 b <br /> Filling/Grading $150 Boathouse $500 t r <br /> w <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. 'ro 1 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> r <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ° z ‘ <br /> 0 <br /> ..--- m <br /> Property Owner's Name: • o <br /> Mailing /ITO 1If Ave . itlin r I5. V) 5 -I�1 <br /> PropertyOwner's Address: � `� 1 n <br /> 22 y p �j� �/}� /��p�� City State Zip k) <br /> Property Site Address: j 2)13 t%L1!nt'C. ^d 1 Ye4'� k I1 C`�' 3 <br /> �p ��'' s <br /> Contact's Telephone Number: �� 2—S7 ,1 t.E i <br /> b <br /> co <br /> Contact's Email: aidtinQ b(“A. c 1 CA �oec, C YYJ <br /> **If staff has a questio about this application,you will be contacted via email. Make sure your email address is N E <br /> legible and your email provider will accept emails from the following addresses: BurnettCoun .org and o <br /> @BurnettCounty-.org <br /> a. <br /> @BurnettCountyWLgov °0 <br /> 'l .� 1� <br /> Legal Description of Property:PC'I &AL "`•', 11 4 J (144,5hore) <br /> 5. <br /> Section#: I I Town#: q 0 N Range#: I q W Town of: \j7S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ,.� 0 <br /> number;found on tax statement): i i c , 8 <br /> Tax ID#(1-5 digit num ) �� {{.�y��� �µ y �. <br /> Proposed Use of Structure/Addition: �(,(1-nen 1� ` ,l• /hy atr w f l I Cahr <br /> Anticipated Start Date: f, � � (Hoare/1 . Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:J,(,,f rf (('x-(K.CF-/�J Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY PcJ <br /> THIS PERMIT IS SUBJEdC-T TO ALL CONDITIONS LISTED BELOW: <br /> imee4- ail <br /> to4- +,, ore( b-,,i; ici , ‘e-iret <br /> 0 1-cc-lt k altA; 15 l7 - " , . Orr ,re C - 4" Ltd )9 6 / x Fee Rec..__ )_dO <br /> 7, <br /> g Check#: Ica:, i.t. <br /> M <br /> 10)3 /a3 e <br /> Date of staff'site visit: ini ial of s' vis• staff: �') < �:-=..,.�., ) <br /> m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 'D y�3 im <br /> y m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o , ; fffi <br /> 0 <br /> ,- . i WI <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> g ‹ <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 5/2023 v <br /> .g <br />