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LAND USE PERMIT APPLICATION—Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line c Ct.I: <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> i; �1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 e ` 10, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 S° II <br /> •Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. K <br /> Property Owner's Name: St-an t V--G Si\OCIke c , <br /> o <br /> Mailing 10 0 Sk Cdv �4 35 Cc n c- n rA hl 1 ,0g-t '' w•o <br /> PropertyOwner's Address: z [► <br /> I � n �� \ City State I Zip E _ 1 <br /> Property Site Address: 5a�9 C.c..lr ,� r�x V"-e.�jf� �1 5`%913 o �y r; <br /> Contact's Telephone Number: 11,5-au00-ao3\ <br /> Contact's Email: C.,.SN►-edberq es-ru. vroA t,k,VdI,{s c bn1 <br /> **If staff has a question about this application,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 °Q <br /> @BurnettCountyWl.gov oo <br /> ,_I Q ,�j1 M r pil <br /> Legal Description'1 of Property: <br /> �bq YV 6"k1 oc S 5W, Se 5� • <br /> Section#: a Town#: 3T 1 N Range#: W Town of: L.Ancoln v, <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): I 0%13 <br /> II y • Q <br /> Proposed Use of Structure/Addition: r'M� `�l i t" "'J <br /> W c Q <br /> Anticipated Start Date: P'.1 5,b (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) �` ; <br /> Building Contractor: AC�u(Ca ( ,i Lel.1 noN Sewer Installer:(ROSSVC VO <br /> AREA BELOW THIS LINE FOR LAM)SERVICES STAFF COMMENTS/CONDITIONS ONLY 7d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0mft+ klx-'Ix s <br /> 0 bMil/CAn j 11/0+ -0 t -e d S 66r't ns 122✓ SAfN # I i1`I4 ' aid rare-23-3 <br /> g Fee Rec:3( <br /> Nod 4D -fate LlQft htiAj. res-Mchon 1 Check#: tea. <br /> i <br /> ni <br /> Date of staff site visit: 1 /3izaq I• ti Initials of site visit staf• �— iD <br /> iD Oil <br /> (� 7,, m n 3 Il u lJ <br /> APPROVED BY LAND SERVICES OFFICI ,G(, ,r�%F DATE: 7/5l202L1 . m c° > <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF N 1 - [MI <br /> 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT M Si <br /> Page 1 of 5i l I j1jij <br /> Burnett County,WI Land Use Application—Rev 5/2023 J <br />