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LAND USE PERMIT APPLICATION — Burnett County, WI a R <br /> Applicant Complete All Sections Below This Line o , <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 en <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Qr.- 0 <br /> X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure /$150 - : <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r" • <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> 0 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> 111 <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. ,` <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> p <br /> Property Owner's Name: Mar k 5, +-Tom c�:v r) 6" -mil <br /> �°a. 00 <br /> Property Owner's Mailing Address: 2..1 1 1 5 fit Ar, . Rd. Fred el-it- W . 5L 3 7 n E. <br /> City State Zip ° W 111 <br /> Property Site Address: 217 15 Mar e k- R ci Fr e. cii C. , WI . E4(33 7 o N , <br /> Contact's Telephone Number: 5t`7-41;3 '-3IZly L -4cty- ) (o1L`(v70 -q$J /`�'�T,y,may ) `k <br /> w <br /> Contact's Email: i'n-t 6 .L't.V Ck+ C\mail . corn ', <br /> **If staff has a question about thiapplication,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: @BurnettCountyWl.gov a °O QQ <br /> x go <br /> Legal Description of Property;S>~C I Z.TN 31 k'9 I A(99e a £ to['oC2 Aif.. SE fW i c6ort-t.3(711L4) 57 <br /> Section#: 12 Town#: 37 N Range#: 113 W Town of: 'T;- j(t Laic.c. S. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* . . vn <br /> o <br /> Tax ID#(1-5 digit number; found on tax statement): 2 3i{Q<3 <br /> + N g d <br /> Proposed Use of Structure/Addition: Cold 5j'Fo r c *I.)ecl -3 7)' N <br /> Anticipated Start Date: 3CFt O[+ LOLN ( e/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> s <br /> Building Contractor: T b C d ci Pfmi Vi t d Sewer Installer: n jA <br /> 0.1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: c <br /> < e aGI(r1(1 C c1 < <br /> 01\fRi+ wit 5--Hba s <br /> Fee Rec: <br /> CZ I r1141.4(2)1414z Check#:Nod b� I/ �O ��n� <br /> 0 <br /> MI <br /> Date of staff site visit:612 120211 4- /3/21)2M Initials of site visit staff: K 1 + Gil._ > 0. m <br /> c1)/y /2i4' `�APPROVED BY LAND SERVICES OFFICIAL: DATE: ,, <br /> 0, LI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o o <br /> cp c <br /> cc <br /> m NJ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTinni <br /> Page 1 of 5 — �� J <br /> Burnett County, WI Land Use Application—Rev 04/2024 <br />