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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> - Applicant Complete All Sections Below This Line <br /> <;,mit Types and Fees:(Pfease,check appropriate boxes) 1 <br /> velling/Principai Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 �G <br /> j°_cmmercial/Industrial Structure _$300 Addition/Alteration to Commercial/Industrial Structure $200 ct 1 <br /> #Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> L lAccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 i <br /> s }Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> E !Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse <br /> $500 <br /> ':�-;ar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) _$100 <br /> __ .after-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> :x;nication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. RI <br /> i :e; is not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0 <br /> L r <br /> . ., :_.rty Owner's Name: l/ G>r V'fl N� S et i7�f ``) t.k''Q-('�a�i` , NV).^�� <br /> ,pz,rty Owner's Mailing Address: DO 1. --i)j�k6' ! '- U,i (L t - <br /> l"_ City State Zip <br /> ;-_ty Site Address:_ g7 T`C Fa S!J 1.' 4 S(a-,A.: e� �Zi vttok.rr �„� 5t i? c <br /> : .:,.. 's Telephone Number: L I�5 3 '3 f g 70 (pcc?'t 9/ — Zf7 9 <br /> .nct's Email: u C r ave (.1 � <br /> ) 1 'V f a�O F1A p <br /> staff has a questiotYabout this application,you will be contacted via email. Make sure your email address is a' l'1 <br /> :bie and your email provider will accept emails from the following addresses: @BurnettCounty.ore and = N <br /> rsurnettCountyWI.gov l <br /> Iescription of Property:U!'i' C91% 5 -D `s x, ttet` zt�NtkXu: e$L{ r`f� <br /> j�sr 1--0dg' 5? >V°''wa Ev- '�,'1\a.� <br /> _ :;,'-#: S Y Town#1 14 U N Range it: i, W Tow-n of: ,J 1,11,1V ^i N <br /> __. It additional page if needed for lengthy description OR attach a'copy of the deed OR attach tar system property page.* � �Q <br /> ))#(1-5 digit number;found on tax statement): (o 'L1 LI <br /> W <br /> :,,ed Use of Structure/Addition: Y'� / a `eM C'e —,f}e r wt 0k-ti\-e- _ 6' <br /> :gated Start Date: Sa— I ` o a.S . (Home/Cabin;Commercial Business:Bedroom:Deck:etc.) o <br /> • Contractor:. -e kr v-Y JC ) e C-'k &IA_ Sewer Installer: O s C t-(A f ii / 41, Z S c"C' <br /> A.X A BELOW THIS LINE FOR LAND SERVICES STAFF-COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> D MR e,1- ate - - s N <br /> t bv\x ,AA ni Y\o- -exceed 2 bed.mrns •e r S fl-I -2)-1-2 I Z <br /> b bt cl,o4 +0 f 1C(ee d 1104 ke i)i+ re 5-f-ri c-k Y1 <br /> L <br /> Y <br /> Z <br /> I)at of staff site visit: ICI&'I202'1 Initials of site visit staff: I __, L_____) <br /> —_.) <br /> )PROVED BY LAND SERVICES OFFICIAL. I DATE:)D f/ 2.02y a ; c� J 11Z <br /> ao <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a @ 6 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 g <br /> Page l of 5 $,� Na `� <br /> Burnett County,WI Land Use Application-Rev 5/2023 1 i 1111 <br />