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416 <br /> .17 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a E. r <br /> Applicant Complete All Sections Below This Line a. r V <br /> Permit Types and Fees(Please,check appropriate boxes) °. <br /> �•Dwelling/Principal Structure Addition/Alteration to Dwelling/Principal Structure $200 <br /> \ d <br /> E. <br /> Commercial/Industrial Structure $300, Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) r 7`$150 Addition/Alteration to Accessory Structure $150 V <br /> a <br /> -, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' <br /> ° <br /> Filling/Grading $150 Boathouse $500 <br /> - <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100H1.. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' ' 1_� <br /> y <br /> z <br /> _ o . .. <br /> =`j Property Owner's Name: ,)/4/P( l /t/2) o A r <br /> a. <br /> Property Owner's Mailing Address: S �U S i t_l ��L l �� E. n % <br /> City State Zip <br /> Property Site Address: LJ 1 `j fi 12 7 -Li Li 3 < <br /> PD <br /> Contact's Telephone Number: -7 / ` 7 el/ ` 1--/S�.J c +-•.,.... °. <br /> C 'jM017�e d <br /> Contact's Email: L.,)_"tom `7 e2 ?..0 "'C.:0M � — . e0 J 9 tm..a TV i CO B'`'\-- == <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and e. . <br /> @BurnettCountyWI.gov 00 .mot" <br /> g,1Legal Description of Property: (tCA C1 L c C7. <br /> Section#: 3 Co Town#: 3 ci N Range#: / (o W Town of: t4 e A' o IA,— . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number; found on tax statement): l ", j <br /> )r ,-3� <br /> Proposed Use of Structure/Addition: - D to eell t ,�1 <br /> Anticipated Start Date: (Home/Cabin;Commercial B Bess;Bedroom;Deck;etc.) `�v N <br /> Building Contractor: Sewer Installer: 5 r. eizeZ Y r1 I L .r.),..‘ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 Gy r tiarI- u 0 c �v+$)4 c__c..-74 I, 1c Ns 1-A e4 tit Per ram.,,74, ItS <br /> t? /Uo ikhor p/ulnnbAN/ Q'_/lt/(3�. Fu7'Fu� /pct-1 Yee an 14&F 3O©.�- <br /> par f of 'ill S ?•e,✓'AA a p p YD Uct'. A I _./� / / s Fee Rec: <br /> () ip�v `,,,,t' I � NI pp_2 '— a0, 1 ori44k �/�/e 7) Ae. o Check#: <br /> o <br /> ✓e yv 10 I21l/zoz`f, a 3o s �J^ g1/, o <br /> g Ca p�+'' ��fQlls toed� keused fMO may' �' c, <br /> 17/ <br /> Date of staff site visit: Z ZOZ� Initials of site visit staff: IV/— <br /> APPROVED < r -.BY LAND SERVICES OFFICIAL: cur ______DATE: 7�,// 2 / bill] <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z B z 0 <br /> SIGNED PERMITPERMIT APPLICATION IN PLAIN SIGHT <br /> r oo <br /> V°LST ©F ye4Y %7�/-MuSf �2 S� Q�DI4lN a Page 1 of5 ' 11111 <br /> Burnett County, WI Land Use Applica n-Rev 3/2023 0 <br /> cn <br /> o r a � Pa 6 7�iS S, a L� J <br /> 5� t� cma7`etll�I.P•V` �, e yjo► or ��Mt�y <br /> D <br />