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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> Applicant Complete All Sections Below This Line w <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure 300 Addition/Alteration to Commercial/Industrial Structure $200 N'v <br /> Accessory Structure(Garage,Shed,etc.) $15 Addition/Alteration to Accessory Structure $150 ,��, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 'N,....e�l <br /> C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" <br /> 0 th <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 g) <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `o <br /> �c <br /> P.,„, <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t^ I 1 T <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> 0 <br /> Property Owner's Name: Rex. /-telr2 <br /> �I �i b <br /> Property Owner's Mailing Address: g(Q()g RtVenlftet,O Lrl (Bfto�; nark 14 5 77 E. <br /> t� 11 ,�,,ii 1 ,iIty State Zip E <br /> Property Site Address: 1 1'4 `--r e ms-4 Rd 1)0-1.4Dty't� tot 5�C T C <br /> Contact's Telephone Number: (0I, .'7`to.59 S 9 . CD <br /> Contact's Email: re _hatee o'\"Q`ct,A‘k.,(CO m <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .T1 M-- <br /> I— i <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and y, cm 1 <br /> @BurnettCountyWl.gov A / r I oo I <br /> 5. <br /> Legal Description of Property:La 11 BloCkZ ?►//4f0-(O kI ndSbores t0 f he n OFAtk(4/l ci 3. <br /> Section#: 142 Town#: 410 N Range#: 142 W Town of: O4 k/an d . ..!.- . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N E y <br /> Tax ID#(1-5 digit number;found on tax statement):!2/217 1 <br /> .-C <br /> Proposed Use of Structure/Addition: PtCnc�'►' +.V \kOr1 a, <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,,C <br /> Building Contractor:7G•f15S�Y13 L.LC_ Sewer Installer: i� <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ,...._ <br /> Oryle0 a se- Js -6- <br /> 0S--nA q no 40 be 80 -e- hwvan ha/DI u--h'W <br /> z Fee Rec:J' <br /> Check#:/42.93 <br /> rr, <br /> r <br /> a <br /> y� III 2 0 L J <br /> `�Date of staff site visit: (I /Zo3 1 Initials of site visit staff:k� < a <br /> iCt <br /> r nn <br /> 'A <br /> I u m co <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: 2 7/Z(�Z3 0 <br /> a 3 <br /> ni n ( , nnl <br /> N Jell <br /> Page l of 7 ° o = <br /> Burnett County,WI Land Use Application—Rev 5/2023 N ,� <br /> L )) <br />