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Lip <br /> LAND USE PERMIT APPLICATION — Burnett County, WI n <br /> a J <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees'Please,check appropriate boxes) <br /> X <br /> Dwelling/Principal Structure � ) Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 u1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 <br /> G <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. C.1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o =(11 <br /> . G % <br /> Property Owner's Name: COrw‘or M H✓^ / o t►' <br /> Ict ` 0 lV � <br /> Property Owner's Mailing Address: 5%00 C.ire .- 4�d- el , Gok'�tfl Uw1)Iy NON 5541 6 b <br /> NVA <br /> City State Zip S <br /> 'v Property Site Address: /A <br /> Contact's Telephone Number: (QI2'"2-10 — O1Z= n. <br /> v <br /> Contact's Email: ,. Lai t,o. to P.Dnn.��( .1O % <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N <br /> legible and your email provider will accept emails from the following address: (rBurnettCountyWT.gov = b0 — <br /> B' .-.1 <br /> Legal Description of Property: ,12L ta -TA 41 J 15' S 0. Gas L 4 0. N <br /> Section#: Town#: 4 t N Range#: J 5 J W Town of: 57 i 5S 0' oN <br /> *Attach additional page if needed for lengthy description OR attach a coPy of the deed OR attach tax system property page.* ✓, W <br /> q N k <br /> Tax ID#(1-5 digit number; found on tax statement): Z1 Z 3 �, o <br /> Proposed Use of Structure/Addition: 4'q�, tY¢a Cttib�.f 1-Eer l <br /> e, N^o Cltcs�Ft v< O `, -i <br /> Anticipated Start Date: ZC1LA (Home/Cahin:CommercialBusiness:Bedroom:Deck:etc.) <br /> Building Contractor: miSe,t-P Sewer Installer: ON 7 W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> UN <br /> 2 n ID+ +o tXreed IzcinS S11 '23 5 m <br /> a Fee Rec; <br /> NivtAbil9 �bT ,�/if ° Check#:,/'�Z <br /> J <br /> PPl`t Ar 4>7 address by LiI1S/zDZy <br /> Date of staff site visit:2-in 2 02 q Initials of site visit staff: 1 <br /> APPROVED BY LAND SERVICES OFFICIA : DATE: L3710024 a ` J <br /> i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF c I E2 0 <br /> � = o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a 0 --a uu <br /> �� N <br /> Page l of 5 c3 -� <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />