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LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> . _ <br /> Applicant Complete All Sections Below This Line 5' v, w <br /> Permit Types and Fees(Please,check appropriate boxes) CI. <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 — o \ <br /> Accessory Structure(Garage,Shed,etc.) $150 V Addition/Alteration to Accessory Structure $150 e..i a <br /> R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 p� I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < Q w <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t N '` <br /> Filling/Grading $150 Boathouse $500 <br /> rn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? A <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '5 G <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. , - -z 3 <br /> ` , z <br /> Property Owner's Name. C:5 h �fSA-yvto�rl o H o_ lib <br /> o <br /> Mailing 0.(, 9UV5 - C t Li La hey\I IC- li'I� j5c�yy b s; <br /> tac <br /> PropertyOwner s Address: ;r, <br /> Q City State Zip <br /> Property Site Address: 6Sc�t O -t 0 7 0 5 i f r rt cil< <br /> co <br /> Contact's Telephone Number: 6 t a a 9 585 <br /> .. <br /> ) N d <br /> Contact's Email: Pt (A I'll b i.e.)e I�3 mc, : I , c Qry N : <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b -� <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and MI6^ <br /> @BurnettCountyWl.gov I <br /> d N — <br /> Legal Description of Property: 0-7 " O(g - "D.- 3q- lb -35 -s 0 5 O Oa- O i's (o O 3. <br /> Section#: 3'D Town#: 5 i. N Range#: ( ,., W Town of: Yil e e.t 0 el <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f <br /> Tax ID#(1-5 digit number;found on tax statement): 323 <br /> Proposed Use of Structure/Addition: GS-6,f ay_ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �1 <br /> Building Contractor: o'n1e OW yke"( Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • MUL-i- u,U- StA-oc J-S (cri-kcc t tO-pr S►d-e SQ,4-bac- c- <br /> •Nc" Alt) U,Std -6\Ua,m cw\ - <br /> Dt 1 VID�.S S ro h,� 0,-4- 15 . bill - - ,re .t Gt-11S l zYl IAA`� y Fee Rec: /5-Q- <br /> c.4 Check#:02 0..p3 <br /> re ttAA. re INA\ fir,,-}-taY m <br /> z <br /> CA <br /> Date of staff site visit:11 ( 170tS Initials of site visit staff ( rri <br /> z_ <br /> < Uul] <br /> r- � i~innnn <br /> APPROVED BY LAND SERVICES OFFICIA ,P�DATE: 1//7/2o23 <br /> cA tnoo <br /> -a mg, <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o ° r ) _ <br /> rn �. <br /> z c� Cr, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT x r o r....3. <� <br /> Page 1 of 5 0 wffil <br /> Burnett County, WI Land Use Application—Rev 3/2023 o a (.... J <br /> va <br /> 3 <br /> b <br />