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• <br /> r <br /> • LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0* <br /> 0 <br /> Permit Types and Fees(Please,check appropriate boxes) d <br /> 00 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F C) <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure .$200 o <br /> xAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Q o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' hi0 <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> iv <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. r �CD 1r_ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> o <br /> Property Owner's Name: 366�t v. Roo+' S o 'L N <br /> J- n W W <br /> Property Owner's Mailing Address: /9 7S , e / ,!� ..Sl/l�+,U it'e !l) j S'�yr ° n <br /> 11 ` ity State Zip 5 <br /> Property Site Address: Lc)i li 3 S�y 1 w,1n.'` )e f, IA)e6S-\-zr UJ \ S VS`)3 o �, <br /> Contact's Telephone Number: 7 6. _ yo 6-go y_R CD <br /> d <br /> Contact's Email: J1i� -:n cDc+9S C 6-04-, 1 (c'%vl <br /> CD <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: @BurnettCountyWl.gov °Q <br /> Legal Description of Property: sky/i yl1- 6 /e el A c/(PTO Ulc jckyc:-VS. y'/ti cf;C L'o 74 Y <br /> cro <br /> Section#: g2 i Town#: I/n N Range#: % S— W Town of: c,L k,S c> ., �' <br /> IF <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v' <br /> Tax ID#(1-5 digit number; found on tax statement): 8 3 S 3 <br /> N ci <br /> Proposed Use of Structure/Addition: 5 A-o r•t y <br /> Anticipated Start Date: y-I-a / J (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v� <br /> +I 1' <br /> Building Contractor: CI id n;Ckcn'c% egi �a`Y, " ' Sewer Installer: - C} " UJ <br /> AREA BELOW THIS LINE FOR LAND SERVICEg STAFF COMMENTS/CONDITIONS ONLY rrir z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z xJ <br /> 0 <br /> 0Mte,+ �U �,-�(�.c)k-S mi <br /> x <br /> rn <br /> 1�, 1^_ 1,,' ' f_' S-bt- <br /> PqZ1+ 'TV of r r Wl,l(YL,I 1 1,1"TLt. 17 CA <br /> CA Fee Rec 1 502 <br /> '1 <br /> (Deck feed.S �vIci it, ftrrY►,t-i- bLi 5iIIzo2y z Check#: rJ`110 <br /> 4pp1' -Far address by 611 /2b2-.H g <br /> q � / - < I <br /> Date of staff site visit: tl l �Zy Initials of site visit staff:"ly</I �- (�lL rri <br /> �J <br /> APPROVED BY LAND SERVICES OFFICIALG ' �'� DATE: � �f Zh27 a ' li 11 i] <br /> �� / <br /> /UPON APPROVAL: APPLICANT MUST POST COPY OF b W <br /> CD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o o 2 <br /> -.`< IN) v <br /> — <br /> Page l of 5 3 MU <br /> Burnett County, WI Land Use Application—Rev 12/2023 LL JJ <br />