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b r <br /> LAND USE PERMIT APPLICATION—Burnett County, WI 5 <br /> Applicant Complete All Sections Below This Line 5' io w <br /> a. <br /> Permit Types and Fees(Please,check appropriate boxes) a <br /> k' tY) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 9 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <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 g <br /> Filling/Grading $150 Boathouse $500 w: <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. il <br /> t <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. k <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. n <br /> l I- O <br /> Property Owner's Name: J Ct in(5 (�et S'1(-in-- -- <br /> Property Owner's Mailing Address: C 't< 0 Q �Hw �\�C h mc:;tci,, . o j E, w <br /> i p City State Zip y c C <br /> Property Site Address: i N)A � )`pSt -'7 Lc,P� R erj , ,5"7 IS— 7 $ i D.isSi 1 <br /> f OW; '..iI ,1Contact's Telephone Number: a <br /> Contact's Email: C(t 0 t4 11 e in YI ejttC2grtsQ . 1 . c o m 0 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b w_ <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °:I b0 <br /> @BumettCountyWI.gov o <br /> Legal Description of Property: iAi'14 it i NC✓r•+Ih`in 1:1.es car bP) no 4 6• <br /> Section#: t 1 Town#: 39 N Range#: 1 "7 W Town of: fik.c K En <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i ' <br /> Tax ID#(1-5 digit number;found on tax statement): 161-C f W a_ <br /> H <br /> Proposed Use of Structure/Addition: Q P;cit se H C o)e, <br /> Anticipated Start Date: I j/a 3 ome/Cabin;Commercial Business;Bedroom;Deck;etc.) ( <br /> Building Contractor: Dt't.4_1 Ce;illp;,ty`C.+I er Sewer Installer: ice:.4i 5.--d(V?r <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I� <br /> � <br /> (p.D.velii' not -b exc f a -- <br /> 50-23- 06 <br /> et vP ko le cod;ho✓l5 o vA R-a -I 7 <br /> II <br /> UP �d Skol1° L'ilt f c5-}-o rd bro o <br /> Fee Rec: — <br /> Check#:7,4J <br /> Date of staff site visit: I /10 I2-3 Mot''al of 'site it staff: c1 Y t`, + 1 <br /> APPROVED BY LAND SERVICES OFFICIAL:Gi . c.te, DATE: y/;67a",3 : 11 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF S <br /> [rtr <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` a u. <br /> Page 1 of 5 '� i <br /> Burnett County,WI Land Use Application—Rev 12/2022 [J1f <br /> , I <br /> 1 �/ <br />