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LAND USE PERMIT APPLICATION — Burnett County, WI I <br /> 1 N <br /> Applicant Complete All Sections Below This Line 5 ii <br /> a 1 � <br /> Permit Types and Fees:(Please,check appropriate boxes) i L D <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I <br /> I <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ,'� j_ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o )) *1 <br /> Filling/Grading $150 Boathouse $500 fi' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 '• . <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. cp 1, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r -. <br /> !� <br /> Property Owner's Name: A-I2..g 4 / - ,nCk ,vz�/''G ,c6 T <br /> Property Owner's Mailing Address:/1314/7 Sr O, O, / ,Li,5/9� fit I V <br /> Cit . State Zip K-•- <br /> Property Site Address: a&/ Y9 /i ?/L. rtO Weesrrrz! id, '�_ <br /> Contact's Telephone Number: ;/Z. S— 956 Z "T— a 1Z. <br /> Contact's Email: /Y` /4/L 4 4/) 6/ ��aco • co <br /> rD <br /> **If staff has aquestion about this application,you wke contacted via email. Make sure your email address is I6 <br /> pp o --� <br /> legible and your email provider will accept emails from the following addresses: ()BurnettCounty.org and <br /> (a)BurnettCountyWl.gov <br /> 0� l sab 2 l 1 l ' <br /> Legal Description of Property: L'S/�'/ Volt/4 N. ' 1 <br /> Section#: 13 Town#: 39 N Range#: /7 W Town of: /W�_Q , <br /> *Attach additional page ifneeded,/br lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> �"' <br /> PP P' y n W i ?. <br /> Tax ID#(1-5 digit number; found on tax statement): 3 5 �.J !� 1� <br /> Proposed Use of Stn►ctt►reiAc�dition: <br /> 041 Cia-b/� H N. <br /> Anticipated Start Date: Ca do Z) (Home,Cabin;Commercial Business;Bedroom;;Deck:etc.i W ! <br /> Building Contractor:/ Sewer Installer: (�l4 Igo Fs/0 ' <br /> l0 c" <br /> z O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z ',;0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •(fl' &r O 5 v <br /> 6 „Ara tb of 4v etkCeed bec(rcer15 ger 5 -013--1 97 <br /> 0 (� <br /> � c: <br /> Il ti�ce5 do K•rcel o /�d+ kr)/ Aot/ fi ( Check Fee Rec: „. <br /> ' i ' "iielrev" WO o/ CarVl r a <br /> y caril-Ac (4.,...)y y,i-e-r,f..._. <br /> OC <br /> tri <br /> Date of staff sitevisit: ' f 9 it'al,o `site vf• staff: ` +{. 7. -- 7 � . <br /> 3 - n inn. <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: y m ; rn 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r. o w <br /> Page 1 of 5 Z <br /> Dril <br /> Burnett County, WI Land Use Application —Rev 5/2023 tx, �� ) <br /> .4 <br /> a <br /> qi <br /> b <br />