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` LAND USE PERMIT APPLICATION — Burnett County, WI 5 r <br /> Applicant Complete All Sections Below This Line 5' 46 <br /> 'Permit Types and FeesiPlease,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U\ 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 n - <br /> v Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> A Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 vi <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 3 A' <br /> 5 <br /> *NOTE: After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> 7 rt <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. o -. <br /> z V <br /> 0 <br /> Property Owner's Name: /(o 6 e f 7-- A A/e 7/4 , N <br /> 0 <br /> 0 <br /> Property Owner's Mailing Address: 6 � C 7 t4 5 l d�e5���tT� -�-�0'-'s <br /> 3 City State Zip <br /> Property Site Address: S��S 7 fL0vj A;Ye Pr PAAi D C!l y W I o <br /> • : <br /> / <br /> Contact's Telephone Number: 65/-276..76-�T a <br /> Contact's Email: Bob Pe /Lefe_e,/ /" A-Ai/di5 'cO/ 24 <br /> `4 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .0 G <br /> ill I <br /> legible and your email provider will accept em1aillss-from the following address: @BurnettCountyWl.gov = Q <br /> Legal Description of Property:PCL GlDV y Cyr nor I b-�7(g' d Q�r <br /> Section#: 3 5 Town#: LI IN Range#: Ks W Town of: J(�ISS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* m <br /> UJ ° " <br /> Tax ID#(1-5 digit number; found on tax statement):22366 13 6191 O xe <br /> Proposed Use of Structure/Ad ition: CA/Al-I.- 1�47 �b /.)ocA' -� tl <br /> Anticipated Start Date: 6 �� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N <br /> z -L` vi w <br /> Building Contractor: 4Z Sti/J 1--.AA'? L/.�-�I�SL,,t i ewer Installer:_ — 7 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY o z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'z <br /> 0 <br /> cil <br /> 00 -uirs nub- —o Uce ed 6 C 1 kG e <br /> n <br /> rri <br /> © 1• <br /> wo Sti's (S3 txls�l 1s- t� o u 1�k. S SI'�Q,c1 I fa'-1D 4 ` ?ji Fee Rec:P5 <br /> 1 a'`` a(c -tobe rtmDvC.d 10v 130` _f Check#: J <br /> b 12131 �U <br /> �ornbl n ed Ine�1 A Ce/- 1fl�C� �A.t�'/�-( I m <br /> n <br /> _.. , L�m <br /> Date of staff site visit: 5rjg//2� <br /> / /Initials of site visit staff: ("1--IY glT I�,1, <br /> APPROVED BY LAND SERVICES OFFICIAL:d(a,4, l SATE: 512g/�wy g � U u` <br /> - ro W "� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �° -. inn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> M <br /> Page 1 of 5 = <br /> (I_ J/ <br /> Burnett County, WI Land Use Application —Rev 12/2023 <br />