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,t LAND USE PERMIT APPLICATION — Burnett County, WI c b <br /> Applicant Complete All Sections Below This Line 0CD I <br /> a <br /> Permit Types and Fees:'Please,check appropriate boxes) : C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 eD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> A10 <br /> Accessory Structure(Garage,Shed,etc.) $150 i Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200, Addition/Alteration to Bunkhouse $150 G- " ^ <br /> Deck/Stairs/Pa ' /Ret is Wing Wall idewalk Bunkhouse $250 ° <br /> / Driveways/&Campground Structures $1 WI State Statute 59.692(1v)Structures $350 ' <br /> o <br /> Filling/Grading $150 ,Boathouse $500 cn <br /> m <br /> Solar Panels(Stand alone or roof mounted) _$150_ Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. . -, <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. - I. <br /> rft <br /> — o -Property Owner's Name: 1_,1 t' 4 A • 1i LI�.�/1 � ' o <br /> Property Owner's Mailing Address: 9 F7 I 1` :/t MP <br /> j P f r City State Zip 4 <br /> Property Site Address: _ _ <br /> �SG ASS V o,. �,iM�tt' • <br /> Contact's Telephone Number: I t✓ <br /> Contact's Email. ( 'fki (,).6 pjAho <br /> CD <br /> **If staff has a question about�thplication,you w contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov 00 <br /> .. " <br /> Legal Description of Property: Lt__// 1 06,A (1 Paa1'1-6kJ Erou1 1o15) r.'' <br /> Section#: a I Town#: 3$ N Range#: 11 W Town of: Doi 01 e(S <br /> n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> / <br /> Tax ID#(1-5 digit number;found on tax statement): . -��(D t N <br /> f <br /> C75 <br /> / // <br /> Proposed Use of Structure/Addition: C LI/�1u% P '4:1+ :IA.9 vt9 a 1/f H <br /> Anticipated Start Date: !!JJ (Home/Cabin;Commercial usiness,;Bedroom;Deck;etc.) <br /> / <br /> Building Contractor: Ut y C 1(6r Sewer Installer: rz OQ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: e <br /> 0��►'s ��i1L ,5 1v' e. yUr aye q NdI �- , ,�t,v�j� k��. A <br /> S <br /> 7L I'D 4C.. LS / .r %uLMQM Gl a Z1747 7f/f. Fi <br /> In <br /> 3 R r K i kt w v/�S a//&Wei lots' �) , v1 Gvt cL st V Ale OS-�8, Fee Rec: ��� <br /> (Jett) ]L ✓ a S 4E4 y 3 77J- z Check#: ,2 I{?j <br /> /o /OW i r►��Gf"I/lDus a y �^P.�k i f vt re-� avid .1 1 ZS,vo <br /> c/c# zs39 <br /> t_ s, ..,&;3__J <br /> Date of staff site visit: 41/2577-4Z.,5— Initials of site vi ' staff: ,/' i/la <br /> DATE: //Z.00 c— " �, <br /> APPROVED BY LAND SERVICES OFFICIAL: �'� ,L,v <br /> cnn ca <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF i sa N. == <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT W�l <br /> Page 1 of 5 3) <br /> Burnett County, WI Land Use Application—Rev 11/2024 <br />