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LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> . b <br /> Applicant Complete All Sections Below This Line P w <br /> r' — a. ' <br /> Permit Types and Fees(Please,check appropriate boxes) laZ' " C7 I00 <br /> Dwelling/Principal Structure $300 S Addition/Alteration to Dwelling/Principal Structure$2Oc1 C .. <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ,� g <br /> .Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , • <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 v) <br /> Solar Panels(Stand alone or roof mounted)_ $150 Permit Extension(1 Year Extension-Allowed Once) $100 ft <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the norms e . 4 Z <br /> 7 <br /> , ampmg i s ign uire a i erent application form;see corres ,and fees. 7 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> z <br /> 0 <br /> Property Owner's Name:0tk‘i ; p i a r o <br /> Property g / 70 co,,,..„ L4 � K C S 1 • <br /> a in ^ <br /> Pro e Owner's Mailing Address: *Y '����c� ti� '/$() w <br /> Ci y State Zip 4 --� <br /> Property Site Address: I7LLf 1 i .� cp �- - t,,D of ea ( o _ N <br /> rD <br /> Contact's Telephone Number: -7 i -6 64.0�- 7 s LQ ca. <br /> C' ] f C7 <br /> Contact's Email: -,,,7 R e,j-e d-(�r1/i ( /'�!)�- �. 1- � CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b —C <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and �' N <br /> @BurnettCountyWI.gov (IQ <br /> 0.Legal Description of Property: O7. 002`1f,c� • 3�' 14—©,: -3—o 3 -OGG'o)Q000 5. A <br /> Section#: el Town#: 3 9 N Range#: j 1 W Town of: A.Li S k E, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W CD F <br /> IV d <br /> Tax ID#(1-5 digit number; found on tax statement): 15 3 So Proposed Use of Structure/Addition: , <br /> R.j1oA .1 ; n <br /> Anticipated Start Date: (Home/Ca�Commercial Business;Bedroom;Deck;etc.) /.' <br /> Building Contractor: twin L 0 1/4.,,-0 ei" Sewer Installer: <br /> ,, F-3)(j\ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> /14IU: CW 2,410(JS <br /> 1b. w-t,ai nl no-- A-D -e X.c ci S bes monrIS V-e-( SkN iMe 8 t29 <br /> x Fee Rec: 23 <br /> fA V�� <br /> o Check#:33c 7 <br /> m <br /> z <br /> V v <br /> Date of staff site visit:II Iril`�Z� Initials of site vi it staff:' i� < ��`J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I2/`1 2oz3 III V, Q. fU <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z H ' <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . o 0 <br /> Page l of 5 3`` w ff <br /> Burnett County, WI Land Use Application—Rev 3/2023 CD <br /> J <br /> 3 <br />