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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> r <br /> b <br /> =• c. N <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees(Please,check appropriate boxes) n^. 0,1 <br /> /X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V} <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 G C <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� 3 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < 0, <br /> c^ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 r <br /> iv IA <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 .4. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. b, <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. 2 C <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. i -'� {) <br /> o <br /> Property Owner's Name: M (* \Az_ ►0/1L Yvl I f\ • • <br /> Property Owner's MdilingAdd ess: a. n CC) <br /> City State Zip E W <br /> Property Site Address: 2 8'`1 C1 t o'l 1_«k 40 bc-rs b,-r) L.t1 5-14 3 c' <br /> o <br /> Contact's Telephone Number: 76 3_ 0_— `I/y 3 C7 <br /> Contact's Email: / ' l, ke Mf"\an 4.4.5"'57 4g G—iti,. a- t'`-''''" CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address:@BurnettCountyWl.gov °0 <br /> Legal Description of Property: �"c `�"4l`"k` ` . ce -A: 0.`2 --5L-`e. V f y 9 <br /> Section#: 1�1 Town#: 0 N Range#: IL{ W Town of: 5 c e N <br /> .. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): t or <br /> I �6 L��O� <br /> Proposed Use of Structure/Addi ion: I-`0`vte / c.. . n. .4' -�_,� ,2 6 x VC `r"ti�i�� N -3 <br /> Anticipated Start Date: 5 I�iki (Home/Cabin;Commercial Business;Be'room;Deck;etc.) <br /> Building Contractor: —r—is n $ 1 Sewer Installer: 1'JVp .r\s <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY d N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: › N <br /> /� <br /> (� 44574 e-K e p� Z A $ P e-✓' S a nl/'7�vy / -r iA / 0 <br /> s�-ti—zY_ s.�. rri <br /> g 5--yam /-,, 0,11 n r.Jc-a/ 710 he- r� v-e-d /o fl- e �'lt. a <br /> ,�,_/ � Fee Rec: 5d <br /> I�el IAA "fete-e- q c,,I ° Check#:f� <br /> a y -� � f�, � � � re9u)v�er� � �f� n <br /> -As 1I , fro IAf Oa/1 712, ic.e__ zti -Pi- -6191AA OHWM. <br /> P <br /> / r� n <br /> Date of staff site visit: 5/ 9/�Z7 I ' ials site ff: yam/- d wIrEi <br /> /// CL Q D <br /> APPROVED BY LAND SERVICES OFFICIAL: ATE: <br /> S��/ZO L/ a `° r� <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF y 0 r..:, Era <br /> o 0 cc <br /> - Ci c Na <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a., r <br /> CD <br /> 0 {moo/A9 IA) a// -E/o 0 0°/4/n /`eru lv'eAm F,✓I 9--�e Page 1 of 5 �� JJ <br /> 0 21re. ,t?f 4 6 e- Burnett County,WI Land Use Application-Rev 12/2023 <br /> ti 49 AUF.,411 A4bI24794o <br />