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LAND USE PERMIT APPLICATION — Burnett County, WI g 2. <br /> Applicant Complete All Sections Below This Line E <br /> itk,„ . <br /> Permit Types and Fees:(Please,check appropriate boxes) y d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 lZ y <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� 'l7 ,. ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 y O r i 1 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o 1 • <br /> Filling/Grading $150 Boathouse $500 CA <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? <br /> ;J <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. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: "gf.E k.T . o <br /> AA IL.n Z. <br /> Property Owner's Mailing Address: 6 yo? � �T Ae� I, �:..^ 4 y t'2 n <br /> City State Zip k' <br /> z <br /> Property Site Address: o <br /> C <br /> rD <br /> Contact's Telephone Number: er 57-518""&/05' o' <br /> (1 0 <br /> Contact's Email: PC).-1."hp 1 '}f 44:-ki 1- 7/ fp 6►'H•-4( , & ''‘'.. <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N .0 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °_ °' <br /> @BurnettCountyWl.gov °' <br /> d <br /> Legal Description of Property: R.:L Ci-)V/ L0t' 3- 4- /0 L, 'V- <br /> Section#: ;It' Town#: � N Range#: 1 6 W Town of: /NA e>✓iN rixj c„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* e ,_, <br /> o w <br /> x <br /> # / ., C7 <br /> Tax ID#(1-5 digit number;found on tax statement): I i 1C' <br /> MI - <br /> Proposed Use of Struct e/Addition: '',r3 `v tcr— <br /> Anticipated Start Date: lio-lc- 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) {J <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 i\Vr "f t o tad -kof Vur o-41 Vkaab i-two'a r I <br /> -"1C k 1 i d be S.a,U,I(ed1 wt-I4rl a '�k- CA� �l n I 1 I'°I21)2�1 Fee Rec: `� <br /> c4 Check#:1064,6(.1 <br /> DAt, SAn,..c,-Gres over osi,F4- No a tan) uce. f e(m 1k Dr 40 be re-wa td 5 <br /> 0r1(2 tL IN) 5p,.rCtV 'Is 6-Li 1# by ts( lq/2026 1) <br /> I, L+'/ , •E <br /> Date of staff site visit: �1 r21 Initials of site visit staff: 14.-r `;� <br /> APPROVED BY LAND SERVICES OFFICIALtat <br /> 11 11I ' DATE: f[91ZhZy c°,+ o <br /> vo <br /> m <br /> CO 0 <br /> Page I of 7 §.- <br /> Burnett County, WI Land Use Application—Rev 5/2023 = a'`i' <br /> os <br /> J <br />