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v, b <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a <br /> 0 <br /> . <br /> Applicant Complete All Sections Below This Line w <br /> Permit Types and Fees(Please,check appropriate boxes) in. �T <br /> C7 �' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '` C <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industrial), $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° N <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 I I\ <br /> Filling/Grading $150 Boathouse $500 II <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> o <br /> Property Owner's Name: Nit-1 1$ 4 La Rg (V`)r^'r) o <br /> Property Owner's Mailing Address: (I -`6+ I%CVit-S LA - 1-14 wiri3siV- L..'l s `13 n. <br /> City <br /> City State Zip k' <br /> Property Site Address: qrt < ' <br /> o <br /> Contact's Telephone Number: 1 t S 3' k ` e 91 I a - <br /> Contact's Email: t ui 4 n 5 to & qi - tvc� . Csb►� N S% <br /> **If staff has a questio out this application, ou 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 io. °Q <br /> @BurnettCountyWl.gov <br /> b <br /> Legal Description of Property: 2- 5. <br /> Section#: Z.' Town#: 4.0 N Range#: I i W Town of: D A);_ii,/✓' u, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ./:: H H <br /> Tax ID#(1-5 digit number;found on tax statement): 3 2.0 7 L. W v b <br /> Proposed Use of Structure/A dition: hA'r $ 40 �,°Co D t ,S.i/ /' eur c✓l i.i� G.r u yr ) <br /> Anticipated Start Date: S/I'L I L 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 <br /> r— �1 <br /> Building Contractor: t°7wr/6. . Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> A�ee- Au 52fb4 �vNv+- li,40144 <br /> Pot P° /��usf b e ray b o� Co/4sc1� <br /> jJ s Fee Rec: <br /> (/ o Check#: �' <br /> m <br /> z <br /> // CA c , , l <br /> Date of staff site visit:5�{10�?3 Initials of site isit staff: ,ki < s I�,�,' <br /> / C n Q trill <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 5 I 1/?3 m n <br /> > < z � v <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o cil N inn. <br /> r 0o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q <br /> Pagelof5 < __ <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 I` JJ <br /> 3a <br /> �o <br />