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LAND USE PERMIT APPLICATION —Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line 0 CD I <br /> (a <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ^ O <br /> Accessory Structure(Garage,Shed,etc.) $150 y Addition/Alteration to Accessory Structure $150 cl <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 L_ <br /> . O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 (� <br /> Filling/Grading $150 Boathouse $500 cn <br /> \� <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 5 <br /> 'NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. ` <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b I <br /> z <br /> t <br /> Property Owner's Name: e4 `Irae.✓ /�j' o <br /> n. <br /> Property Owner's Mailing Address: /3$8j Apo/lo -c / rc,,,6 t /f1 s sZO6 g w <br /> p ('1 City State Zip c) <br /> Property Site Address: a Oaa /23 1•1 Az ,...M.4 4-7 !AI/ o '' <br /> Contact's Telephone Number: (2 32)/ 6tc,]r/ . . <br /> C7 <br /> �' w <br /> Contact's Email: l(Th'LSe•✓ 8 9`/' " / %Ti--",0, C O r•-• <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> 5. <br /> @BurnettCountyWI.gov 5(c A F17i fliedF. <br /> 00 <br /> Legal Description of Property: S�rs 1,4 ,A,,e. V r✓• of--- 7 /t dui 64. /,2 t3 9/�/( p. <br /> Section#: I I Town#: "[� N Range#: ) (p W Town of: &c,�tl4 Q'L cn <br /> *Attach additional page if needed for lengthy description OR attacha copy of the deed OR attach tax system property page.* .� <br /> Tax ID#(1-5 digit number;found on tax statement): I`I Co 7 <br /> g H.d, ...c <br /> Proposed Use of Structure/Addition: Ow-4 e a bin <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c <br /> Building Contractor: Sewer Installer: 0 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ave4_meek �It seNos -�� <br /> ,wtiH ,1 I4b,- <br /> L <br /> {j T� :4_ <br /> _ x Fee Rec:,8 ISO <br /> �-4 s �' - ,011 n 9 h> -t1C tern <br /> , n <br /> S��fi'"� IV)� r) r!o!t-Cry /J Li = Check#: AS <br /> cif Nia$f bt le (avlll%�4b V.c. C •'g�c� 5k✓✓� Mao c Pll�� <br /> al HI <br /> Date of staff site visit: Li I/' 1 p <br /> P3 Init•a of si?�te isit staffH� I' CO n <br /> ��C.� DATE: L /ld/23 m v <br /> APPROVED BY LAND SERVICES OFFICIAL: l m �J <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF _ Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `° <br /> mil t ff ,, <br /> Page 1 of 5 `` J <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> a <br /> %•o <br />