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• <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a r <br /> < b <br /> Applicant Complete All Sections Below This Line 0 �, <br /> Permit Types and Fees:(Please,check appropriate boxes) ? O. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 ,-/� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 3 <br /> ,':'< Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 C! �, <br /> .t <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <, O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 F <br /> ` <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 — .. 6 <br /> `NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> O <br /> Property Owner's Name: VI y fe, e) OW n =' N <br /> §. W <br /> Property Owner's Mailing Address: ag 4 7 75 Cot.)n 4 y Re) H fl er}eA LJ I 5'fi 4 4.5 w N <br /> City State Zip c O <br /> Property Site Address:94775 Cou.47 Rc.'d H Ikc4e l , i.J..i 541645 o ', <br /> Contact's Telephone Number: 7►5 - W 1 I - )31 y Cl. <br /> Contact's Email: Ko c'oLitt 19`)7$p yGhoO, L,prt1 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -0 p <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 2 00 p <br /> @BurnettCountyWl.gov cro <br /> /' i L 1 d N <br /> G <br /> Legal Description of Property: O i1 0 T 2 --•51, �N <br /> Section#: Q Li Town#: 3 o N Range#: I H W Town of: f c;.e. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* H '' <br /> C7 <br /> Tax ID#(1-5 digit number; found on tax statement): g'C�/ 1 a <br /> Proposed Use of Structure/Addition: t'0 IC S h e 01 <br /> Anticipated Start Date: 3/ I / 'a Li (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) FOS <br /> Building Contractor: Bc B raves eS Sewer Installer: q,Gk GI-o u n z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> D I1/14e+ all r-e-I-bur S <br /> O'No-I- -lb be used — r h,uxna,ri 1naaoi- -h tri, S4Drcty an ki <br /> Fee Rec: /btu`' <br /> d Check#: //05 <br /> rt <br /> r <br /> z> <br /> Date of staff site visit: I 9 2O2L1 Initials of site visit staff: / < r_ L.._____ti ).� <br /> APPROVED BY LAND SERVICES OFFICIAL - /1y DATE: )G f o/zoz / Ei' k inTii <br /> m W : <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o ;; 0 <br /> triili <br /> boo u <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , w <br /> Page 1of5 < a `A' <br /> Burnett County,WI Land Use Application-Rev 5/2023 d <br />