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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) , Cl. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 r_ <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ok,c i <br /> CD <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 a <br /> Filling/Grading $150 Boathouse $500 y • <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> F.- <br /> ‘? <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. co <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' <br /> Lc......- e..... <br /> Property Owner's Name: ati,, i<ek-- <br /> Property Owner's Mailing Address: fora Ar1E'1 4 Het 6' `1 1V.D �/( <br /> -,:,.± <br /> �; 4 City State 3 , <br /> Property Site Address: � /�A� ��t"�°'�-1°�- � �7 �T t? e - <br /> 59 o a <br /> Contact's Telephone Number: �9� - 87 ?) N o <br /> Contact's Email: d0n/6eft-e-Clot. ep a <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -c <br /> legible and your email provider will accept emails from the following addresses: ABurnettCounty.org and or <br /> (ThBurnettCountyWI.gov o N <br /> .feel �(/ ill,S u. w <br /> Legal Description of Property. 4i <br /> Section#: 12. Town#: '7 i N Range#: I 1p W Town of: S-14,(S% c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 7CS —CA ) 0rt <br /> $3 <br /> Tax ID#(1-5 digit number; found on tax statement): 36107 <br /> ,_ <br /> 0Cls <br /> Proposed Use of Structure/Addition: Z th <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' i <br /> Building Contractor: Sewer Installer: Vi J <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> @kett at st-1-lurks s- <br /> (29, VU f_ 40 !� ud'64 .f.t„ karati 6,10i-id-iba , Sqtra-9-e °A tY <br /> Fee Rec:J5Z3 <br /> d Check#: /U Z,Clicb <br /> m <br /> m <br /> > <br /> z <br /> • <br /> Date of staff site visit: I z/s,/2-62-S Initials of site visit staff: __ <br /> a <br /> H <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 12 O <br /> g W rrl C <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -cn 8 g % <br /> Page 1 of 5 tri a co <br /> Burnett County, WI Land Use Application —Rev 5/2023 d �� <br /> a <br />