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, <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a a <br /> z: N N <br /> Applicant Complete All Sections Below This Line 5 a ? <br /> Permit Types and Fees(Please,check appropriate boxes) = d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <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 /> Ca <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °, `k <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 NI <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. `E ' <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9. z <br /> 0 <br /> Property Owner's Name: /' �r� L- �d//�L> . , o6" <br /> 79ii PA.�/< �r- J ,,l<43v4 Y_ fgf. 7 b <br /> Property Owner's Mailing Address: c• ri <br /> ��/�rty S to Zip X <br /> Property Site Address: 7gtl Ai Ke 37-- ���x�2y //!"/ J`�� o y <br /> Contact's Telephone Number:Xed e � //91I93�/--� 7/5—6 3',-1/..3` a <br /> Contact's Email: /Wc /')� /v diem L' ' zi,,vt- a <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: @BurnettCountyWI.gov� c. °` <br /> Legal Description of Property: k ��1�/lr' 5 ,�/V V&/...0641 /A4/ P <br /> Section#: /9 Town#: l v N Range#: /0 W Town o 2O(2.13 q S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system erty page.* 71 , v) <br /> 0 X <br /> Tax ID#(1-5 digit number;found on tax statement): /�[f;�,Z, g d <br /> Proposed Use of Structure/A.dition: - ,EL . d / �� J i 4.1• • / / -3 0•1 <br /> Anticipated Start Date: /%1 ' /j,i / / (Home/Capin;Commercial Business.Bedroom;Deck; Gg�i©� �i � <br /> _�!II , 'J 7 �/4 ixij�/C.7/S/,V C.11 <br /> 1, <br /> Building Contractor:�, d q► �,�Tj�/L�J� ewer Installer: , N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z �-- <br /> (� THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: P, <br /> D MU YYI:P,Q+ l o-c+ siciQ 5.2.-1'0cOL clAct cxiu otmlz5t-} l tc k-S <br /> t'4%)A,V•;T‘r1) n.D-- 40 4 Y-ce td Z �,,' s Ft( Sp.�i Y-b 5Cc o <br /> rn <br /> vl <br /> � ,�,y, 1 _ -11"" Fee Rec: t W . <br /> StY 1 L `11- - t i d e.e u l'-e d lib- a 1 V c4 fir/lA-i A U 1 t 12D1LI z Check#:fijjg <br /> (��mi�ervla�iS Sv.rfoc e 'IS WA- 'tvc reuS n' (,;,-W► r2vnava� t5� rnu� �l e bui1d tn9 m <br /> �7(� (�, n <br /> Date of staff site visit: lii �L, l Initials of site visit staff `"� v <br /> APPROVED BY LAND SERVICES OFFICIAL:'1\�,�1�_-l/0M./D/ DATE: q/r7 z 9 : ir- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFx r <br /> c <br /> ..,.. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD <br /> CD/Si-des 4 12 feVI GUS buald,i n)S Page 1 of 5 <br /> t)k*A-4 51ck 0.6 19(0 fat j Burnett County, WI Land Use Application—Rev 12/2023 L <br /> Ifill <br />