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LAND USE PERMIT APPLICATION— Burnett County, WI a 9b <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees(Please,check appropriate boxes) a w <br /> c Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 OP <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 1C1 F <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n p) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 (- <br /> Filling/Grading $150 Boathouse $500 T <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. 1D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 ' <br /> z <br /> p <br /> Property Owner's Name: to i c N AC t- ( kc ro;k - <br /> N <br /> Property Owner's Mailing Address: 2-'ll k."\ c c. t'— c Vh E -) L,rl i 5 cc,L)00- ak-)1 5 1- I w <br /> 5 n N <br /> City State Zip c' N <br /> Property Site Address: C PMk < <br /> Z. o D <br /> Contact's Telephone Number: R( S -''.1 i,A _ ZAH 0 a <br /> 6 <br /> Contact's Email: NA l(C ( 2 K<r-):', ,o Cs _ CA tA :° <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o 0 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov ° <br /> 5' <br /> on <br /> Legal Description of Property: 1, 4 tL%S[- (3 P : t H c,1 ; s q <br /> Ei <br /> Section#: 0 Z Town#: 33 N Range#: Iq W Town of: t)C L.1 oQ <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): 31 (v O — N g 0X <br /> Proposed Use of Structure/Addition: M As I C<- i3 e b *- 6Pvt.0 A , ;i D ^-1 --I W <br /> Anticipated Start Date: EA^ilx.'d l (Home/Cabin:Commercial Business:Bedroom;Deck:etc.) <br /> -3 c./,‘_.r q.' <br /> Building Contractor: S F k 4- 4- c q.7--6.n c i v(1- i E C, Sewer Installer: f Pik p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> OPe4 at Se r S <br /> i <br /> Dwe,ton r1O-- -b -ex(eed 2 b L1 S P-( Sf9 // 22422rrl <br /> (�Il'� rl nzeded Oft SZC '` lidis� by �61/2vZy o Fee Rec:.2Cx�(,k 1,,�'w^ � � Check#:���(etren-f need -kr teX.�enShrt 4 S-fuirs ;n) fo flee �a�e by Ir�2yYP- <br /> List wed 4-1-rorjZflA°uS 5ur-Foice. An/ -C,&-the import v�eimen+s L.;;l l re jui re rPalr el 22� rvt�+�'�u+-;on <br /> �= <br /> Date of staff site visit: Initials of site visit staff: 7 C l�'u <br /> _ rrJJ 2D2 y _� <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: G. Z3� c"' <br /> v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Mal -- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT figW <br /> C <br /> RS <br /> Page 1 of 5 o f <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />