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LAND USE PERMIT APPLICATION - Burnett County, WI a r Applicant Complete All Sections Below This Line 0 c w <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) C7 QO <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> ..ti <br /> Aommercial/Industrial Structure $3' Addition/Alteration to Commercial/Industrial Structure $200 �c-� p <br /> ccessory Structure(Garage,Shed,etc.) r $$150 / Addition/Alteration to Accessory Structure $150 Z_U\ <br /> Accessory Structure(Commercial/Industrial 200 Addition/Alteration to Bunkhouse $150 6_ <br /> '�' Deck irs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � (' <br /> Driveways &Campground Structures 5` 5 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <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. <br /> z <br /> 6110.1 <br /> ' o <br /> Property Owner's Name: l^1G.`fin Po(' o <br /> ��11 + SoS(o <br /> Property Owner's Mailing Address: S 1'���l� S '- NOS" �I o�•,C t t'- Nl n <br /> nn City State Zip ° r) <br /> Property Site Address: o2:7-1 E.2- 1.-t_e g-00.0Y ,we-b&\-Cr� l0 o <br /> ii <br /> Contact's Telephone Number: 6 '2 - 3 5 g- o 8 1 c <br /> Contact's Email: G QAe n., Pa ces ` S t R.P. e-Un•C.s, CO NE <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: @BumettCounty.org and 0 "Q <br /> @BumettCountyWl.gov A. <br /> LP\ e- s�-C P..Legal Description of Property: N z- J if 7 0 NI w b S A:- 4-.CLcc) /.&o f <br /> o <br /> Section#: 0Q-10 _Town#:__Q_N Range#: 1,1 W Town of: 0/\-1 r. C4 <br /> *Attach additional page if needed for lengthy description G 'ich a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number;found on tax statement): 6 5-6Y 7 t7 <br /> Proposed Use of Structure/Addition: le-C tolecr,V,ot, I Pcrso r`o.i u S e- 1c of <br /> Anticipated Start Date: It 11! .3 (Home/Cc ;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: ft ok- d,��e rw,,1 cd. y L* aver Installer: N I A <br /> z `~ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAF, ''OMMENTS/CONDITIONS ONLY <br /> THIS.. PERMIT IS SUBJECT T/O ALL CON_ ITIONS LISTED_ / BELOW: r M <br /> 0 AV- k uS - Aume7 vlail/ 977�ii • `\ <br /> aN\ <br /> I0 DrnVe u 4 >A I1e_A—Y-- LA.5%l /AehL re?1-,1 rewr 016 <br /> Z LFC: 1 ( <br /> 0.5./a0 !! <br /> it <br /> Date of staff site visit: ////,,7/' z3 Initials of site v' ' taff: //T x \ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 05/04 z3 cn cll. <br /> rn 0 Ind <br /> u <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o --.10 <br /> r, m 52. N ) <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o `� ll <br /> Pagelof5 < =`` w inni <br /> Burnett County, WI Land Use Application—Rev 3/2023 v cn z <br /> 3 <br /> b <br />