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e <br /> • <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line z <br /> co I <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> d V1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `o '�J'I <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 u1 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 . 0 FP <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> (.k Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c ^(� <br /> Filling/Grading $150 Boathouse $500 ,' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `• <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. lb <br /> z <br /> 0 <br /> Property Owner's Name: k i yv,�r‘y 1tJ�1e,‘C..r F. ....... <br /> \a. <br /> Property Owner's Mailing Address: 321, hi. "V%Suns-in g {, ejr Y115b W L 5t4 it 0 �. n 1\ <br /> City U State Zi E. <br /> 4c4 <br /> Property Site Address: 0aCagi ?Ct A " 1Z..c4 D(Ae0,wei W 3 4- S'4 <br /> to <br /> Contact's Telephone Number: —71 S- (o�314 7 .lg. <br /> a <br /> Contact's Email: ._WI\a Wa sd 1Q,n 0 y(„►1 W vO. C v <br /> **If staff has a question about this appl tion,you wi l be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov = ay <br /> 5 <br /> Legal Description of Property: C L A r o F V yerZ51 D 1-,(?M e,S LoT /D d <br /> Section#: 6(p Town#: 40 N Range#: I(p W Town of: °G.k.t 6.0C1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* cn <br /> p w <br /> Tax ID#(1-5 digit number;found on tax statement): I LI 3 63 3 x• <br /> py t t7 <br /> Proposed Use of Structure/Add'tion:(A` 31a�G Y� i!1; dii•)L Der -� c \c {ao.i. \ H <br /> Anticipated Start Date:O$(..31-)5- (Hom(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> x <br /> N A <br /> Building Contractor: SQ)g Sewer Installer: OQ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ° z <br /> THIS PERMIT IS SUBJECT <br /> TO ALL CONDITIONS LISTED BELOW: o <br /> 6 Stidsmo7 74, lie use-' �r A icrvl h 74 <br /> 46i7�4 oh. <br /> a Fee Rec: ��� <br /> 4413-- <br /> °z Check#: 5412/ <br /> r <br /> cn <br /> 0372,0a-t/1 � // <Date of staff site visit: Ini ' is of site ' ' staff: // �7i Z. ___J l J <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: Z 3 to 2. › <br /> MI <br /> c, <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <ao —00n <br /> m 5.1)... —� U u L <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br /> Page 1 of 5 <br /> Burnett County,WI Land Use Application—Rev 12/2023 1111 <br />