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LAND USE PERMIT APPLICATION — Burnett County, WI = r <br /> L C C <br /> Applicant Complete All Sections Below This Line 5 N <br /> Permit Types and Fees:(Please,check appropriate boxes) F <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 `N� o <br /> x Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N <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 ro" ." ~• <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 Q <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o ' <br /> i N z <br /> Property Owner's Name: Mt ke, ',LC&Vr lL 0 0 <br /> o <br /> �1 �/ G <br /> Property Owner's Mailing Address: ht 7 peek-pa 1 /Zc )1tk ,V(/ i J1)13Q .. n <br /> City / State Zip E <br /> a <br /> Property Site Address: SVYI o <br /> Contact's Telephone Number: <br /> 12- 71'- Z ©(.., <br /> 0 <br /> Contact's Email: C1Avi._( 3(0ttc yahoo d C0m FO <br /> **If staff has a question about this applicatidn,you will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and =. ° Z 1 <br /> @BurnettCountyWl.gov ZQ . p� +� - 'Vc, <br /> Legal Description of Property:itf- —�J r path QG ttai4-/ �Dvag ' YdI) /d uJn et_11 Jt►r 8' <br /> t <br /> Section#: i 0 Town#: y 0 N Range#: 15 W Town of: is ac K5 u, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F py <br /> Tax ID#(1-5 digit number;found on tax statement): 6 C� ?? L-- d <br /> Proposed Use of Structure/Addition: (J cur A.96 — &`j-oram- e fl <br /> Anticipated Start Date: 5 -.15 2- J (Home/Cabin;Commercial Business:Bedroom,Deck;etc.) Q Qj <br /> Building Contractor: Sewer Installer: .L- CH <br /> D <br /> 'z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY xi <br /> / THIS PERMIT IS SUBJECT TO ALL CONDITIONSS LISTED BELOW: ,� _ <br /> CIL aTS 4 ie co m AioLP� V/4 G Cc v-7i`1 '-r 3 >uI^ Mei,(C.51i3 U\ <br /> toy /o/,/�z G / / 1 <br /> 6NOf be- uS�• it' Limon `jq[�/ ' '4/1 Check <br /> Ck : <br /> e <br /> d Check#: T <br /> r <br /> ta co <br /> Date of staff site visit: 3'5 �-LJ`' / Initials of site visit stafts'KT . Gl '' a <br /> i <br /> 71, <br /> APPROVED BY LAND SERVICES OFFICIA DATE: 3/7/Z.02-2/ z c <br /> > m na . <br /> N n 0 Erg <br /> 1� <br /> Page 1 of 7 ' CD co 0 ," c <br /> Burnett County, WI Land Use Application—Rev 5/2023 K cc x• <br /> �' ICJ <br />