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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 3 c <br /> 0 ;'� <br /> Permit Types and Fees:(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 5 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> f <br /> *A Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 N �\ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 . <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ` <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 izt <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> M <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o 2 <br /> 114 <br /> Property Owner's Name: 7-f.((,0ettl fS .ffaiej SreQ Ss` 03� F 1 ° P. <br /> o. <br /> 6q 67 Q�eE a CIV <br /> Property Owner's Mailing Address: N�f/e1/ILVf / /'r <br /> ^ Cit� A State Zip <br /> Property Site Address: 30/33 /� i l/vi V/- 04A/I �' 1 c <br /> Contact's Telephone Number: 60 'pl- -7/0 —S'/30 a <br /> Contact's Email: ‘1-_Saa i 6.14 e- (�Mil l 1 L. O`'✓t <br /> **If staff has a question about this application,you will b ntacted via email. Make sure your email address is N .d <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °° <br /> 5' <br /> @BurnettCountyWI.gov .Zo7 a v ('M F 8uI r•Tcov.vTY ...)A-kt17/5fn/5 ki✓E/(l'/(.(d <br /> fe <br /> d <br /> oC4--rsG/n/ ift Sw Qv44Tfr OF TOE S� ev42TF< OGS6.<-77 / ,,'7Cw <br /> Legal ofProne �i/ ^/� � n>�6�f� v� ToN�wS°'Q`e4£TT �� . <br /> Section <br /> Range �o / �i� rcn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1.4 F x <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> 2 e2(o1/.� vvV" c,t <br /> Q H <br /> Proposed Use of Structure/Addition: �''e! e�T H ,• <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) b <br /> Building Contractor: Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY P, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 6" <br /> P L plk etl o c- <br /> teor \irc, knok •-or 6.6*66tOn <br /> Fee Rec:/ <br /> �011ela VAt Of il d Check#: /Q3( <br /> m <br /> r �J <br /> O �_� <br /> Date of staff site visit: 617,1)IA Initials of site visit staff: 6L <br /> 0 Ui11 <br /> APPROVED BY LAND SERVICES OFFICIAL: NA- DATE: 7/Z//2978 tr1 CD`D CO Z <br /> -. G_3 <br /> -nn n .�"-. IV I('��} <br /> ,n CD Ina <br /> L <br /> Page 1 of 7 0 o o Q <br /> Burnett County, WI Land Use Application-Rev 5/2023 -< cm <br /> n <br /> rra L� )) <br />