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LAND USE PERMIT APPLICATION -Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line o' b <br /> w <br /> Permit Types and Fees:(Please,check appropriate boxes) n <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 V \ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 G O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 a <br /> o Z <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 a <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> Filling/Grading $150 Boathouse $500 , <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. q <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 /> Property Owner's Name: ,9 et: K IL A-s=,^11.E /lc,& Z i '. <br /> Property Owner's Mailing Address: /(5 7 7 5 l CA <2.2,L ,,s�c: /" �00 ,,7,So 7'/ a <br /> �j StateZi <br /> Property Site Address: 6 /j L 9 / /C f r /2044 W(/ City-�14. i S te Efj ?3 IT, <br /> Contact's Telephone Number: <br /> Zio2 — 2oS - `.5 . <br /> TY <br /> Contact's Email: /Qr K r ,4 Z C.. Q V f A 1A Eli , C OM AA a <br /> **If staff has a question about this application,you will be contacted via Jail. Make sure your email address is N ti 1 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °0 <br /> @BurnettCountyWl.gov R? <br /> f r / O VI <br /> Legal Description of Property: LO t 1O� A) ne-# CcLl'i y` CC''7 S /sup So b <br /> Section#: /3 Town#: 3 9 N Range#: /7 W Town of: Li/)LcD l n i . c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of he deed OR attach tax system property page.* o x <br /> Q W a <br /> C7 <br /> Tax ID#(1-5 digit number;found on tax statement): � C� 9 <br /> C. <br /> W <br /> Proposed Use of Structure/Addition: 7r"4�%z:,.. S rJtG/ lh <br /> Anticipated Start Date: OC-` /,3 ,10,y.3 (Hone/Cabin;Commercial Business;Bedroom;Deck;etc.) t Il <br /> Building Contractor: My i ,Sc_/ Sewer Installer: Wade. /1 ofrS176"/ 5co G <br /> z -0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7y <br /> THIS PERMIT IS SUBJE T TO ALL CONDITIONS LISTED BELOW: <br /> mee4- aif 5C+6 <br /> Ncf ci j,44/non A.6,`I -I)'6' ei;, <br /> z' 5 Fee Rec1 � <br /> o Check#:-750 <br /> rn <br /> r <br /> a <br /> z <br /> a <br /> Ilcip <br /> Date of staff site visit: 1 D 3)9-3 Ini ials 'te visit staff: c1 < __JJ <br /> / , n sy f <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7D/k,��� i , iffil <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o a W <br /> r m ry <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT en " `� <br /> m OC N o <br /> r 'O <br /> Page 1 of 5 < , w <br /> Burnett County, WI Land Use Application-Rev 5/2023 0 CD 111 <br /> b <br />