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LAND USE PERMIT APPLICATION - Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line o c <br /> PP P CD , <br /> Permit Types and FeastPlease,check appropriate boxes) a <br /> l7 W` <br /> Dwelling/Principal Structure $300 K Addition/Alteration to Dwelling/Principal Structure $200 0 :pp`� tv <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 X3 O <br /> f <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 u1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t <br /> << <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c 7 <br /> Filling/Grading $150 Boathouse $500 cn <br /> a <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. & ` <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> v <br /> Property Owner's Name: 5 P6NGeg- 14 /LF T2Usj =' 1J i <br /> a <br /> 0. <br /> Property Owner's Mailing Address: O I B A eGW en_y G/v / S,QL1 Q l9 J c0 8�a o/ N ' <br /> Zip k) <br /> Property Site Address: ZZ -/7 �D-/v.SSG g.. F j/tJ e 1 W f ,City 5 y�5 7 o N <br /> • <br /> Y'Contact's Telephone Number:/ 9 52 / - — 4'2.3� a- <br /> Contact's Email: VV'q-ri vi4/00. co/4C <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ro QO <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov °0 <br /> Legal Description of Property:_LQT 2 n SA7 v S fi 17 GN/eoP arc) <br /> Section#: 3 5 Town#:/3 6 N Range#: /$ W Town o2 / ?LG6%%F - U1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* CA <br /> w 0 x <br /> Tax ID#(1-5 digit number;found on tax statement): /0/8 3 o 5Proposed Use of Structure/Addition: 3 S J cr) PQRC�-1, av ) scr2 l' j\ -i P O <br /> Anticipated Start Date: F6 6 /S, 20Z (Horne/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> , � / /� / s tnl 57 <br /> Building Contractor: /L Ei✓ G/71 L[�� CONS' Sewer Installer: ! `�/� 7, 00 LA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z .X. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z 7 <br /> 0 11/k+- Ct.0 St+64-3 ,,, <br /> rn <br /> GI <br /> Dui-mu-Lill 11.04 40 X,c.12-t-d 2 he d-roDmS per S rt-N 4 1013 2Fi <br /> rxi <br /> ( Fee Rec: aOO <br /> z Check#: 5/ 7 <br /> -, <br /> -t <br /> m <br /> ^� <br /> Date of staff site visit: 21121Zegq Initials of site visit staff: e r f l <br /> N = (n <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 2//3 21:2 y -3 -r1 CD C <br /> u U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �, <br /> a) � o Inn <br /> 0 o 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT D N <br /> Page 1 of 5 co <br /> MI <br /> Burnett County, WI Land Use Application—Rev 12/2023 ________JJ <br />