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LAND USE PERMIT APPLICATION - Burnett County, WI L <br /> Applicant Complete All Sections Below This Line cn w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> b <br /> ViDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cI <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \ O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 6- <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> V Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> 11, ID <br /> Filling/Grading $150 Boathouse $500 F. kill <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. ilk <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z 0 <br /> Property Owner's Name: 4' /' &ci.SO-, ge/Avgj& CC C 'n ' <br /> p n /t/� C°n v <br /> Property Owner's Mailing Address: 4-74T t7 P�2E7 , Li K& 7/€ It4'tif 5-3-0e r® ; <br /> /,Of qsS hed yef )6 274 w gCity ,l Let to ail) <br /> < 0 <br /> Property Site Address: © Cj�� o y <br /> 1.1 <br /> Contact's Telephone Number: 67"6-'2�Z y��'6` <br /> Contact's Email: ,697//e- r've7 ch'YG l"� c/f 974. CO/L/ °Q <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N '17 O N. <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °° <br /> @BumettCountyWl.gov C p, <br /> J�Legal Description of Property: �QieGG�/ lax7d (oc -ed ‘vvQrhl1-iej" /of 5 6- <br /> Section#: 3 Town#: j y N Range#: � W Town of: ,eases <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . 21 r <br /> Tax ID#(1-5 digit number;found on tax statement): 35f 4'5 V W E3 <br /> Proposed Use of Structure/Addition: //46e/C6I6 h `' !V <br /> Anticipated Start Date: /O//5/20Z (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> �'id rovfo C!JnS Y'ICi',"i 74 ytore-a-cG'v fl <br /> Building Contractor: PrePe-A2tK,144r- Sewer Installer: frvebsf!; Gt/I <br /> 1- <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Mee+- all 5e-I-bcc 6 - <br /> a ,(Owel l iof di, exc.-eci 3 pC-r <br /> ,vt��''s 5ft /-)3 -a i/ <br /> Fee Rec: l <br /> Check#: 5 27 <br /> tri <br /> o <br /> Date of staff site visit: )(4)/a-3 itia s of 'te sit staff: Tr S �—= <br /> APPROVED BY LAND SERVICES OFFICIAL: -� DATE: I o/l /?j tii <br /> cA coti' co. C) H <br /> � <br /> ^an < 3 —II <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF oCI.CD <br /> y n <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT g K N C <br /> Page 1 of 5 P 3 `.`' N <br /> Burnett County, WI Land Use Application—Rev 3/2023 a I <br /> a <br /> 4 <br /> b <br />