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• <br /> • LAND USE PERMIT APPLICATION — Burnett County, WI a t~ <br /> Applicant Complete All Sections Below This Line 0 c w <br /> ,o CD <br /> PP P , <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure I,,I $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> V Accessory Structure(Garage Shedfifcg"S $150 Addition/Alteration to Accessory Structure $150 <br /> ro <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse _$250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c r\ <br /> Filling/Grading $150 Boathouse $500 \ii <br /> p <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension Allowed Once) $100 <br /> _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. $ i <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;sec corresponding application,and fees. <br /> *Items not lister'above will be treated as accessory structures,such as:pergolas,landscaping,etc. a.' z <br /> 7_ <br /> I. <br /> Property Owner's Name: flip J E ,Ii •f o cl o �1 <br /> Property Owner's Mailing Address:33S-7 21 xe-, ,f/ O Al sT iv ik) D A/b 6 in it) S-3 0)7 Er. <br /> ) City State Zip ° `" <br /> Property Site Address: 4g58 -1y's7o CY /� �/ I 1 Z o <br /> p a <br /> Contact's Telephone Number: j 7 113 / ! 6 �1 <br /> C7 <br /> w <br /> Contact's Email: =% <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro ()1 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5 °Q <br /> @BurnettCountyWI.gov MINNEw&uKON KY ASSEsoc , PLAT <br /> Legal Description of Property: LOT 11 + 2 PE ftceNT INT til OtxrLAT 3 <br /> Section#: 21 Town#: L4 I N Range#: I S W Town of: SA.A SS c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> Tax ID#(1-5 digit number;found on tax statement): 2 2 7 31j vi IV <br /> t7 <br /> Proposed Use of Structure/Addition: ` 1-O i ,.-3Q ,c\(}u d 7' N <br /> Anticipated Start Date:___ ( e/Cabin;Commercial Business;Bedroom;Deck;etc.) ,...0 to 0 <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> ►D Met+ ail S;-Fa S <br /> : 1\)04- toe- use d -(-0( \Aiwa r, I60,-ku,-66(1 <br /> x Fee Rec: I 50 <br /> l-J�` S4 k v\ ,mod bLf �0 I t j2DV Check#:C'415/1 <br /> m <br /> z <br /> ?? v <br /> Date of staff site visit: II /Tt 1201J Initials of site visit staff` —T x ° C ) <br /> Fi <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: I I I S f'LU2 3 w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o anCr)Cr3 CD a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o ``, <br /> Page l of 5 `< CD <br /> Burnett County,WI Land Use Application—Rev 3/2023 v cr, ill <br /> a J�j <br /> K <br />