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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> a b <br /> Applicant Complete All Sections Below This Line 6. (-95 1'1* <br /> Permit Types and Fees:(Please,check appropriate boxes) C1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 5 o \ <br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 S, 4 <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 0 _ 1 <br /> Filling/Grading $150 Boathouse $500 �, <br /> U7 , <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. r ' . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. e ' <br /> Property Owner's Name: �t y 1rJ�� '(�+ r`aY� o <br /> /J I , <br /> Property Owner's Mailing Address:/4739 3(—` T�VC So \c 4��-1�. ,c� r ' rr`�"a� w, r <br /> `� / Ci State Zip <br /> Property Site Address: 30a l S l-t Der 11 vt�a1Vt- !Ake Ps _ r '��� S4g3e Z o <br /> Contact's Telephone Number: 1 —3B6,, - 41,ei(-- a <br /> d <br /> Contact's Email: <br /> QSr0rr'\6) r'nY4j <c J-4cp <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N o a <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °G <br /> @BurnettCountyWI.gov rm .` <br /> F. <br /> o N <br /> Legal Description of Property: r I Y5-L A A -Ea Se(,v. Lea Acres Lot as a�o 4 o <br /> Section#: fi Town#:1,4/t N Range#: # ;' W Town of: SWISS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I d <br /> Tax ID#(1-5 digit number;found on tax statement): 3+o 01�— N <br /> Proposed Use of Structure/Addition: z`Y �� ' Q <br /> Anticipated Start Date: /O— 18 aa?-4-- (Home/Cabin:Commercial Business:Bedroom;Deck;etc.) N <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 /> ((Meer au 4, a-s s <br /> d No4- +) b.e Used -R„r' h 61tAA-t kuJoi4r,-i-i°ti /56 <br /> V 1 ew 112,(1.. pow SU ffbf"-i-S needs 0. L a-nd use- Ft(rA � by 1211 I 2D2 zi g Fee Ree:/ljtf /c/62 <br /> l I 1 ei Check#: - <br /> g Lads -b . I� ll Cornbivied � a Cer-kfiee Suvey mar 64 6/1/2°2S ... ��. <br /> itia <br /> cD <br /> Date of staff site visit:/0/0/20Z/1/ Initials of site visit staff! T .; <br /> / <br /> APPROVED BY LAND SERVICES OFFICIA �/L/ ) DATE:/0//S��QZ�/ , <br /> na r e <br /> c= g ® r- <br /> Page l of 7 'z r.. <br /> Burnett County, WI Land Use Application—Rev 5/2023 Ng' 9 <br />