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LAND USE PERMIT APPLICATION —Burnett County, WI a c <br /> Applicant Complete All Sections Below This Line 5� w <br /> Permit Types and Fees:(Please,check appropriate boxes) da <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 M \r O <br /> Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 CD <br /> 9 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ' <br /> Filling/Grading $150 Boathouse $500 j <br /> CA <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 k % <br /> 'a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. q <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r g <br /> _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o =' <br /> �j Z <br /> Property Owner's Name: aR1iO4Z1 ,4 Ii7 L"MRI, ri,,I'1 /D)k .+2, " . i. <br /> o <br /> o. <br /> Property Owner's Mailing Address: /49 7 7 g1 YEozoknws ,e /1/EL. s I'%/ 5/697 E " n <br /> ik <br /> n ',� / CityjA/ State Zip <br /> Property Site Address: �j33 C �� A (/v6gST ta_ l'P/ 5 yeg 3 o 7, A <br /> Contact's Telephone Number: 7IC 79 i 29 c 1 f Cn" is�u�l4 a <br /> ll.. ( e <br /> Contact's Email: GW/C/1 ICfeA 1 ,, , <br /> **If staff has a question about this applicati ,you will be contacted via email. Make sure your email address is N b <br /> legible andyour emailprovider will accept ails from the followingaddresses: @BumettCounty.org and °0 <br /> g p @ Y g 5. n <br /> @BurnettCountyWI.gov oo <br /> d <br /> Legal Description of Property: 51''✓ 5E (itv CsMT 533/27-r N <br /> Section#: 332. Town#: 110 N Range#: /5.--- W Town of: Jger(sorl c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* *I E x <br /> Tax ID#(1-5 digit number;found on tax statement): sgli <br /> Q 1 N d <br /> � <br /> Proposed Use of Structure/Addition: Sratvie, 6A446 c .� <br /> / <br /> Anticipated Start Date: $ep /j 2z2.3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: rItO Fit iP4✓/ Sewer Installer: <br /> I z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �,THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> C /Vof 7--e, / e usCd 6r 4u ,.tea14 kebi74r7`faa) 74-Ai's I's G <br /> 9p ) 9e- -G,i" Sltgg e, off / • <br /> l ? Fee Rec: ,Ill 1 <br /> o Check#: ,,„,. _V <br /> m <br /> r <br /> Date of staff site visit: /1//7/ 2 3 Ini ' s of site visit staff: /, ti <br /> Rid <br /> s. CD <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: &AOZ_3 so 0 <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF ; HT-ili O <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT : 174 <br /> w <br /> Page 1 of 5 r. <br /> Burnett County,WI Land Use Application—Rev 5/2023 <br />