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a <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o 6" <br /> Permit Types and Fees:(P/ease,check appropriate boxes) a Q(� <br /> C7 X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `` <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 G1 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 a <br /> :? <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r r <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> c <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 /> ro <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. a <br /> N o iik <br /> Property Owner's Name: S i Pi -I- 1 P tilt U 16— -T. b-tyy il .Ti i- W. lo <br /> o N <br /> Property Owner's Mailing Address: �j i jo C ASTL i'iD ti al RI), tAili -O O yy <br /> LI JO s1 s . <br /> City State Zip 4 ...0 lk <br /> Property Site Address: 9 3 92_ kge,y 1r-e_e, gcl• o <br /> Contact's Telephone Number: 0 co <br /> Contact's Email: S e -e<zt01i %' "1 it(L, C.,/P <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov o <br /> = b° N <br /> Legal Description of Property: Dai-l?Ir l-f r-i-bl) O (iv Lc'y- j ' 4 22.0 d S' <br /> 5. <br /> Section#: 1 0 Town#: 11-0 N Range#: j W Town of: J� A/ s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* "'O <br /> Tax ID#(1-5 digit number; found on tax statement): &t I f 4 I q 12 V 5 i <br /> Proposed Use of Structure/Addition: ( f3 <br /> 1 � <br /> Anticipated Start Date: 6'I- � (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> /", .-3 (c_ <br /> Building Contractor: 2I L4 Sewer Installer: ,) Pr C k 5e). fi <br /> C' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY °m z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o z N <br /> D Meek au St S <br /> �v f n o i- -I-0 .acee.d S b�d,l n 5 fl-N-24 -�3 <br /> L.INt VIq )10-�- -k) (text 4-ex(text of f lu,i) + rt S-Iri C1i oft o Fee Rec:.(t <br /> -4-0 be bui ) <br /> J `4- a+ Ala r dG,k c Check#:7 <br /> -"C(�is pe.,,r.,+ is {-tr -Rill d bota i ni Dn!`i t 16116( 1 <br /> 3117 c� tri <br /> R <br /> Date of staff site visit: 31 I 1 [ZO2-Lf Initials'of site visit staf 4- G� v r— �I�,��,I <br /> APPROVED BY LAND SERVICES OFFICIAL:C� U ✓l/l 7 DATE: /22/ZØ1 a c 3 if ill <br /> tl <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF t 1 In�ni <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ c4 <br /> K IV1� <br /> 3 <br /> nn' <br /> Page l of uuu <br /> Burnett County, WI Land Use Application—Rev 12/2023 .J <br />