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LAND USE PERMIT APPLICATION -Burnett County, WI ? c <br /> b <br /> Applicant Complete All Sections Below This Line - <br /> Permit Types and Fees:(Please,check appropriate boxes) ,L '-,' ''''. <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 --- W�\ <br /> 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse ,$150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk % Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ! r' <br /> Filling/Grading $150 Boathouse $500 <br /> _ _ <br /> v: <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 /> C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 1 r J <br /> � <br /> �Qj r -, V` <br /> Property Owner's Name: Sad- o <br /> / �/ 0 <br /> Property Owner's Mailing Address: i im) 3�' Ave D 114ifeapdil fv 5`5�1q n <br /> p p City 1 State Zip K <br /> Property Site Address: Pike fit'e PI l hem Dam. P,d -� < — <br /> Contact's Telephone Number: Lit tit; 3 <br /> 7-6 6 <br /> q <br /> Contact's Email: 5 'Wk4' %1 S)_ @ O Mt1.il, (d/vi =' <br /> **If staff has a question about this applicaq' n,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: a BurnettCountyWl.gov = r <br /> Legal Description of Property: NW A/lid C/` ' j-3.' =. <br /> Section#: 3 6 Town#: `j I N Range#: )6 W Town of: SW/SS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* `4 <br /> o ^ <br /> �3 <br /> Tax ID#(1-5 digit number:found on tax statement): 2 W � X <br /> e <br /> Proposed Use of Structure/Addition: JYli"cha{ 1 ([t,b��) N --i <br /> Anticipated Start Date: (Home'Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> N <br /> Building Contractor: 119 IV- (Sc t/ /k ' v) Sewer Installer:/��ile-" ,i0 phmm+1bi ij m <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Z v ,0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 �01104.9 bull tOuSe- re_7a/Ptr-+A7LS_ L <br /> 0 e-e- e� e.a r c a' To C o r e-c it.,/ / .x� <br /> Qn�ve.�ay n5 �f <br /> ' Fee Rec: �— <br /> cu / f(' l /r9gAt Sze-irna ' .iy 1211/zoz ' Check#: aI 4. <br /> 6 Follow(!0w floe 4 A/4 I'�,p'f�/11�/{A4°Wl TS. a <br /> Date of staff site visit: 6, Sr- Z&at/Initials of site vi • taff: o 6 <br /> niffil <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: G ZOZ m co M <br /> 3 -< 0UPON APPROVAL: APP CANT MUST POST COPY OF [� <br /> o c ,� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> ti <br /> 7 Copt L J Ud� h5��r 4� ��^ /2 MI 'r 1 oft CD <br /> ` r Page �� <br /> s' S�'yl�Dlpty,)jN9 Jobe- Burnett County, W Land Use Application —Rev 12/2023 <br /> 0 / fyo/w\ e.- n'v b ,z///zoZ y <br /> ►�1 � Pyy <br />