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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> ro <br /> Applicant Complete All Sections Below This Line 5' cn <br /> Permit Types and Fees:(Please,check appropriate boxes),; i CO W <br /> G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 r w <br /> V <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Rj O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 't z <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> k/Stair Patio/Retaining Wall/Sidewalk �- Bunkhouse $250 <br /> o <br /> Driveways Campground Structures (" $125, WI State Statute 59.692(1v)Structures $350 0 ;� <br /> Filling/Grading $150 Boathouse $500 <br /> v) <br /> Solar Panels(Stand alone or roof mounted) _$150 Permit Extension(1 Year Extension-Allowed Once) $100 `✓ <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. �b N <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' Ilk <br /> o <br /> Property Owner's Name: A44NE/ /_.1 P.Sv/J o <br /> O - <br /> a _ <br /> Property Owner's Mailing Address: [v)©© A i'TU (LiV3 gp 8L0�()►N t u41-0.1 A / JS43p/ n C)1 1 <br /> City State Zip ° c.0 J <br /> Property Site Address: 25 C,l"12 w 0_43-5 L.4 .IE RD i./ t -, w) t Cif 4�33 o <br /> • <br /> Contact's Telephone Number: J e,P Pei{-� v,4Do, LAC; c,"v:;Cr.- 7 a 5. IT7-c75 5" _ .. a <br /> IsMiliGj/ LAR.Sc+N-Cw.dE-►e 6 tZ - Zt)°it—93&.5 e <br /> Contact's Email: "?pJV'It g Ao L-.�01,( N41/G , 1-. I-AR- eJf4'dEI'1AJL ►i.Ci ► <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ki <br /> o � <br /> legible and your email provider will accept emails from the following address: @BumettCountyWl.gov <br /> ' <br /> Legal Description of Property: Pe . 14 0 v Lc-r 5 (L a r 3i,•TQ u_ArNJEt27LA r) d <br /> �Section#: Z 3 Town#:j�f N Range#: R I� W Town of: ytJFF,c,iCt A/ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): N LA g v <br /> g� ) f/��ii.� <br /> Proposed Use of Structure/Addition: cv TEA Tit^p/ i s Pee .4 7 4 i 5 - C <br /> Anticipated Start Date: I'm ha-11,A T-,F-4..y• (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) - --I <br /> E.- <br /> BuildingContractor: w <br /> :rope/K�k- �4p�Ntu� Bch;T Sewer Installer: �, /� CA <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY "' z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: zpz <br /> 0 <br /> 2; 04ef a,U t bat,kp, <br /> F..). <br /> .., <br /> Fee Rec: 12'S <br /> °z Check#:`1 11(p <br /> r- <br /> •C <br /> rn <br /> Date of staff site visit:1 13 t/7oZy Initi Is of site vi it staff:_T o r- l ��n <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: 2 2021 > a �- ,0 u u <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> II <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 = I1 IJ 11 <br /> Burnett County,WI Land Use Application—Rev 12/2023 <br />