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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> z , b <br /> Applicant Complete All Sections Below This Line c w <br /> 1?P P a �, <br /> Permit Types and Fees(Please,check appropriate boxes) . . a 60 <br /> C7 N <br /> Dwelling/Principal Structure _$300 Addition/Alteration to Dwelling/Principal Structure $200 co <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z O <br /> 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 K Addition/Alteration to Accessory Structure $150 cIl <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> VI <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 rr <br /> Filling/Grading $150 Boathouse $500 PI <br /> En <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `5 <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. g <br /> Zr.... ; <br /> Property Owner's Name: YAA/ E.U1eA'i4iD =' <br /> 00a. <br /> iProperty Owner's Mailing Address: 'F� 7X -7,3 l4 % 1 6- 9 r��, ,� Ci State Zi ° `� <br /> Property Site Address: Z ZO iC E/-/c) c L /P4E,i) 93 <br /> o N <br /> • c <br /> Contact's Telephone Number:7�5'1,3 ' f.Z a <br /> d <br /> Contact's Email: 30 U Ra2AiLv y 5,f y,'e Cp/ M/L , �'ii � <br /> **If staff has a question about this application,you wi be contacted via email. Make sure your email address is N (1 <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and 0 °0 ..D <br /> @BurnettCountyWLgov ------'NO <br /> d <br /> Legal Description of Property: f 3. <br /> Section#: 2E3 Town#: 39 G./�N Range#: /7 W Town of: t /`/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N N f <br /> Tax ID#(1-5 digit number;found on tax statement): /0 0— <br /> Proposed Use of Structure/Addition: 14RCiUsa Rain old • <br /> Anticipated Start Date:Noy"23 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: 6E1./-' _ Sewer Installer: <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 /> W t ,+ au Se,-l-IocktkM <br /> 'N a- -1-o be vsta -For \AIL n.a r \Aa 1514C-Fl VI / <br /> L 4 'T�� Y1Q S-e Gl lfrA I�-!'t�` ' C Yl I I ZoZI-t x Fee Rec: ' <br /> o Check#: 7 4' <br /> tri <br /> v <br /> Date of staff site visit:II 2/ZOZ3 Initials of site visit staff U <br /> • <br /> IM <br /> APPROVED BY LAND SERVICES OFFICIALc:<0 DATE: 11142-0Z3 CD <br /> co C, n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF l N Nil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C° <br /> Page l of 5 <br /> cp <br /> Burnett County, WI Land Use Application—Rev 3/2023 - <br />