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• LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a 3 ro <br /> N N <br /> Applicant Complete All Sections Below This Line c CD I <br /> (a <br /> CI. <br /> Permit Types and Fees:(P/ease,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2 <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 e, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 i' P <br /> Filling/Grading $150 Boathouse $500 0, <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. 1 <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. a r <br /> r= <br /> Property Owner's Name: r rr ; f ri- 3- r r, re Z n) 8 -. <br /> Property Owner's Mailing Address: )`'f y g CYv i. 1) LL 4 I9 6// N1 ib •..�Z Z-' w n <br /> �11 l City State Zip c) <br /> Property Site Address: 2.15 Li 6) PL 1 r e f i.),L- L, fee.) dJ�..»))(A� T : -1 5'3 C o i r <br /> Contact's Telephone Number: Lit 12 -3 `;3'.� - 1l3,2 S 1 a E. <br /> o, \" <br /> Contact's Email: d•r n& 1A i' 7\�� ( D'),.. � a6 rvi <br /> **If staff has a question aboCD <br /> us application,you will be contacted via email. Make sure your email address is N -a <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.prg and 7. °° <br /> @BurnettCountyWl.gov P i A) CI-6 3;,;— ' A) I 3/4-34,` °° <br /> t . l oa. Oe — O/ycC <br /> Legal Description of Property: JJ .5 w r ,3 i,\,;JL 5. O <br /> Section#: 3 6, Town#: )I N Range#: I W Town of: ,/j,;:+ S c4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W <br /> Tax ID#(1-5 digit number;found on tax statement): 1 I , <br /> 0 <br /> )v x )4- ' 1 <br /> Proposed Use of Structure/Addition:'&24,6 c� dc�.maii C L�r d 5) IA,//a ice",.,d S ned V\ N <br /> p� `�Anticipated Start Date: 1"� ''��� (Home/Ca m;Commercial Business;Bedroom;Deck;etc.) f\I � % N <br /> 4-', l i)vi I+ . tp 4- de))1)rceC <br /> Building Contractor:h..1 Ala_ t-1i,'Kc t v 3.11 e() s Sewer Installer: z VC. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x \A N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS. - LISTED BELOW: <br /> 6 No - lc, u S e --‘-'r �t u 1AAc IA b a 1 i I1a T7 01'l,, .6 <br /> Fee Rec: /50� <br /> d <br /> Check#: F�� <br /> tz <br /> r <br /> JJ <br /> Date of staff site visit: ..c��/co a Initi of • visit ff: �i/' � <br /> c� p IM <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: .�/✓r/�Z3 `, 'v LD 73 0 <br /> > �' <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF z 33 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m. R.' to <br /> Page l of 5 MI Z <br /> Burnett County, WI Land Use Application-Rev 3/2023 0 �� -� <br /> 'if: <br />