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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> tn: 67N <br /> Applicant Complete All Sections Below This Line z ta <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) 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 5 <br /> Accessory Structure(Garage,Shed,etc.) $150 •Addition/Alteration to Accessory Structure $150 t(3. 4 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 pJ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ,.. ` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c r. <br /> Filling/Grading $150 Boathouse $500 L <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> w• <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro ( - <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. @ 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. P <br /> z <br /> i/ o <br /> Property Owner's Name: /Qer/ e , 7,_ePL 1 ZS o i <br /> Property Owner's Mailing Address: d 904,7 C ) 1 v V) K-E- RD I. n <br /> j q City State Zip °- E �\ <br /> Property Site Address: -3L1 061I.$ 21.200 �G WAtow / Tu(e ZD�t1JQu, J 0.l o N <br /> s- I &lc - a ' i <br /> Contact's Telephone Number: �p 2'✓�'(pQ" �,�(Q /�p�y ��, S el.) �j�o j,� � � <br /> Contact's Email: (Lf „ iti �Ol/ ' . C'Q 1ti` " µ v 3 ` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro <br /> Lvi <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5 °o <br /> @BurnettCountyWl.gov aro r <br /> ` �� I_ o <br /> Legal Description of Property:uLa"T- I CSN1 `p y5 V 5�0�1Y R <br /> Section#: C Town#: 110 N Range#: /la W Town of: OJt' .L wi). <br /> *Attach additional page if needed for lengthy description OR a attach a copy of the deed OR attach tax system property page.* Z G <br /> Tax ID#(1-5 digit number;found on tax statement): 35 L4 4 ( CvS <br /> \ <br /> x s (� qx lb S1E D 4 Deck V1 <br /> Proposed Use of Structure/Addition: E <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ` <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ►n0C4 4(I St"-b 4_4S , ,I e- <br /> "Ited al.A--- -Czw 4LAA4-44 L bi'474-t) <br /> Fee Rec: J 2 -' <br /> c Check#:SO?f/S31 <br /> Al', A aka/Nel sLs fl <br /> 0 CD <br /> En <br /> Date of staff site visit: 1v 1W J :al,of site vi 't staff: J-1 / < QLIAPPROVED BY LAND SERVICES OFFICIAL: DATE: I�ll0l a gl V m ma b•fD <br /> Erg <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF zoo <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT tt 3 <br /> Page 1 of 5 < w <br /> Burnett County, WI Land Use Application -Rev 5/2023 d L-..---J.) <br /> N <br /> a <br /> 3 <br /> y <br />