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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI <br /> L <br /> 2 <br /> Applicant Complete All Sections Below This Line CD w <br /> Permit Types and Fees:(Please,check appropriate boxes) ° <br /> d kj <br /> Dwelling/Principal Structure $300 Y. Addition/Alteration to Dwelling/Principal Structure $200 �. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 W g <br /> ,Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e �l <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 °» lJ�1r <br /> Filling/Grading $150 Boathouse $500 <br /> VD <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. • <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `: R <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. \ <br /> z <br /> Property Owner's Name: �t‘ kti .. -4,2,` r <br /> Rki <br /> i a. I a.,Property Owner's Mailing Address: 2_, . k y kr\tarn VIM fr - 0. i s \ G. <br /> 0 n p <br /> city State ° ci <br /> Property Site Address: 1). (c I la tor• R .Qti k�s is,,- id t kiwci Zip •o <br /> Contact's Telephone Number: ) - .`Ai''77-i I n. <br /> N d <br /> Contact's Email: Poy u.k.• is 6 t..,c a 6 t / .et, i 4,154, 00 a <br /> **If staff has a questi6n about this application4ou will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> @BurnettCountyWl.gov ao <br /> Legal Description of Property: I,-�p (, E. (V <br /> Section#: 3 [ Town#: D N Range#: A D W Town of: a 0.k 1.A r.t, <br /> 70 <br /> 7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 6/-1 g y _ d <br /> H C W <br /> Proposed Use of Structure/Addition: baf,i E fal. c\Lct 4 beck ul <br /> Anticipated Start Date: ( G -- n 4.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z. r— -C <br /> ` Q op <br /> Building Contractor: f\-o @ ;�i Sewer Installer: 60*-7, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •tipktU nc no-� AD futQd 3 ix54,tru S -zo _10 <br /> • �� �"" Fee Rec�W" <br /> J-it�1 Y1 ISekKfL, -flyniVA:l.AA.t Check#: 4:2-1() <br /> a <br /> ra <br /> o <br /> Date of staff site visit: 1'12/20Z3 Initials of site visit staff (( <rc <br /> �-- <br /> APPROVED BY LAND SERVICES OFFICIA,Cr ', 'Vp DATE: " k l202 <br /> a m w n <br /> UPON APPROVAL: APPLICANTMUST POST COPY OF o m <br /> z Lnun <br /> (1) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o= N <br /> Page 1 of 5 <rrl 3 `"'' <br /> inn <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 3 ` J <br /> J <br /> i <br />