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• LAND USE PERMIT APPLICATION— Burnett County, WI `° t- <br /> P <br /> Applicant Complete All Sections Below This Line FD w <br /> GI. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> ti <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,1,',. . P2 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .-F- p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° 11111. <br /> • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r <br /> o ''.1Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 X 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 /> r- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: q N E. /e1 Lc't�L� l S o <br /> o <br /> Property Owner's Mailing Address: ///` 0 '{-)CCttv>i QC _ ' .. V .3i/ 9 <br /> � � K��'�21 W t l� ltyl.t .1---. ^'Stag t75 <br /> Property Site Address: c (�; 1 <br /> Contact's Telephone Number: (51 353 ,- 99 4)6 3 Uhcii i , Co....n. a <br /> ' l <br /> S. d <br /> Contact's Email: Q V\q9 i E. ; dr; k cl k 15 & 6) <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N w <br /> legible and your email provider will accept emails from the following addresses:@BurnettCounty.org and b0 <br /> @BurnettCountyWI.gov m N <br /> �t= <br /> / I 3/ o vl <br /> Legal Description of Property: k- t CS v V, f� �6 1 N <br /> Section#: 35 Town#: `-a N Range#: /5 W Town of: Jl-(<3�'cr' (1)*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 11.3 f <br /> Tax ID#(1-5 digit number;found on tax statement): Go't'I U1- °, C7 <br /> � <br /> Proposed Use of Structure/Addition: C & <br /> Anticipated Start Date: 3 ta 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) .- - <br /> Building Contractor: Sewer Installer: J W <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 /> d Yto kl <br /> otti CeVICI,=-1) "15 Of VAR - 1- /7 4' d LVP-a) - ii3 `si <br /> 0 tt (1 Sit,ore L'4g ae D PI WO A(►St be vej;I, bi 8/l/A z Fee Rec:4� <br /> o Check#: 40o <br /> zm LQ.w�— <br /> .10��1► <br /> Date of staff site visit: 14!6! ?3 I iti of s' e v it staff: )1 < .._...,.....___Lii <br /> rli <br /> APPROVED BY LAND SERVICES OFFICIAL: (i4 . DATE: 14/(0/2'3 . 1- _ <br /> w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o (W 0 <br /> z z. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m o 0 0 <br /> Pagelof5 < m,t N v <br /> Burnett County,WI Land Use Application-Rev 3/2023 d Ind 3 �' <br /> H <br />