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LAND USE PERMIT APPLICATION - Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line CD w <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) A <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 03\ <br /> n <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e Q` <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 -- �' <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r x}, <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `�w W <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 /> 0 <br /> Property Owner's Name: Pa ix-i 8-(A1--J o (� <br /> 0 <br /> Property Owner's Mailing Address: /G/Le 1-/t r1 I Lf E/►f t /2!� a.LM I�krfrH 111.✓ Sf'.317 c� <br /> N <br /> City State Zip 4 <br /> G <br /> Property Site Address: t) (1 it f P1vk 5/. T1w,+wt4 er D .k/t I w l fV f'/3 ', <br /> Z <br /> Contact's Telephone Number: qSa - q7 E -a) c .. c. <br /> 0 <br /> Contact's Email: P 6 Cltl r D e,f k y w6Ll-^C fr-f€i t-C t., - L U LA" CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.c, G— <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ° bQ N <br /> @BurnettCountyWl.gov ac N <br /> q <br /> Legal Description of Property: Teµit{>H f Lit k 4Lat-r I)it,-t F Ye/few Litt k-( 1/4/3015'Ic! I gt-IL 0 14. g <br /> Section#: 10) Town#: L4 0 N Range#: /(.o W Town of: Oa ic.14.4.4 Ex to so' g <br /> >-,,t, N <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* k v o <br /> --D g <br /> Tax ID#(1-5 digit number; found on tax statement): I'4 E 94 <br /> H Q <br /> Proposed Use of Structure/Addition: G'avk'{1 Po/.e fleet <br /> Anticipated Start Date: peltehn h,w /01 (Home/Cabin;Commercial Business;Bedroom:Deck:etc.) r..0 <br /> Building Contractor:(1/1t✓. h to Bw+ (c1)%A S Sewer Installer: ve4 G C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •Nitt-f a Se--E'locA s <br /> • M D4- ..Cvr w'L`v IAC V <br /> in -F � Over tiA- act as t t- Fee Rec: 1VST <br /> r eSL. 11/� �t --6,i ltAfe. . c Check#: <br /> r- <br /> a <br /> {� <br /> q � l J <br /> Date of staff site visit:i DJ 1 /zo23 Initials of site visit staff: T— < r- <br /> APPROVED BY LAND SERVICES OFFICIA ��DATE:`°I fo/2oZ3 O. <br /> W O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o az, - o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD= a <br /> Page 1 of 5 `1 5 K .*) I,,,ti <br /> Burnett County, WI Land Use Application-Rev 5/2023 d 2 I Unit <br /> a `� <br /> 4 <br />