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LAND USE PERMIT APPLICATION — Burnett County, WI L <br /> A licant Com lete All Sections Below This LinePP P CD 1 <br /> Permit Types and Fees(Please,check appropriate boxes) C7 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 cv <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ,eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> 11)Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `& (`` <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. cD r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z <br /> Property Owner's Name: ( E7' ---- Z <br /> 0 <br /> a.Property Owner's Mailing Address: .� lay-`��� �/� �ati'^l6 h'R oe� /�- �p�U � � <br /> 2 3q7`t f City State Zip ° E w Si <br /> Property Site Address: /�z4,24V/ L,q,v .57ie- Lft f wz 32f / o <br /> N <br /> . C <br /> Contact's Telephone Number: 74P 77`7("6"/ C <br /> Contact's Email: , 10A-rGdr SRO& Yftt/aa. jM <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is oa_ <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and i' o B <br /> °0 00 <br /> @BurnettCountyWI.gov a — N <br /> Lor1 or c 'J 1 ✓..,(P /? PcL. /iv 49v L�9 0 :.1Legal Description of Property: . _J <br /> Section#: /Q Town#: ,Y8 A N Range#: /4 W Town of: j/10� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax/system property page.* 7� ^ c V <br /> d <br /> Tax ID#(1-5 digit number;found on tax statement): 32 0 <br /> D ` � f -3 cN <br /> Proposed Use of Structure/Addition: D�>` t'�e-61fi� a c �x iSr„i,(� De,,0S—i i r1�^ <br /> Anticipated Start Date: /t9�r 2011 (Home/Cabin;Commercial Business;Wedroom;Deck;etc.) Z SI'A c <br /> BuildingContractor: 6ca✓.l7crA) <br /> --(t.—/fr Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> .-et4- c U s�.- , s -�b W <br /> Loa and s Yl e-e -ed ty\ S-e,io-l-i c -avt k lid by 121112023 <br /> DI takksicia d Q(ilI \x curitO 1n 4A-Q Sc lkk_ -Coo P''irl+ x Fee Rec: tO <br /> / 6`� <br /> FP-Y. 69. LI 9 (I D r,r,> c,U,ou.A r1, -k1n,►S 11,on COnkor au n.5 c e k +3 be m Check#: <br /> 1r2,elctrl • z <br /> v <br /> Date of staff site visit: 1019 1202,3 Initials of site visit staff: i t < , j <br /> � m co <br /> APPROVED BY LAND SERVICES OFFICIAL c�` `ti DATE: l0llO/Zo� y Q CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z ` o <br /> IT APPLICATION IN PLAIN SIGHT j a N <br /> SIGNED PERM C <br /> Page 1 of 5 w �� <br /> Burnett County, WI Land Use Application—Rev 3/2023 a <br /> Lam) <br /> 3. 1 <br /> .o <br />