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G <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line o w <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> O <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> V/ �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 ° 6 _,\ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> V Filling/Grading $150 Boathouse $500 , <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 7. <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> z <br /> Property Owner's Name: TINl 41 KAYCee 'aRbOKSNAW '° <br /> ' A,,/ a <br /> Property Owner's Mailing Address: 11I3- vi11Okl LA t ��5Ld�' ! Pita/ <br /> //��QQ I, f ,D_ p Cit /� State Zip � <br /> Property Site Address: Blot 1/�''t7' portep o 5p 9; �V <br /> C-C - <br /> Contact's Telephone Number: 195-kao /7 93!. .,� <br /> Contact's Email: ttifbekShetw Pi 6 giAlua '� <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ' <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = j <br /> @BurnettCountyWl.gov , g) <br /> t* C S4 V 2 1 1 �\ <br /> Legal Description of Property: t,C 6 ''1; C 43'D 9 J <br /> Section#: Town#: ,10 N Range#: /'f W Town of: 7r <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H <br /> Tax ID#(1-5 digit number;found on tax statement): 32_1 by <br /> H Proposed Use of Structure/Addition: 'rbl�/e (.1,)(.1,)Anticipated Start Date: "(SAY (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> $ 1.-.) <br /> Building Contractor: NOp%ctu S 14,1) Q►&+4 `'T' Sewer Installer: 4 I.A. <br /> z t�- <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ---T— <br /> THIS PERMIT IS SUBJEC TO ALL CONDITIONS LISTED BELOW: ,� <br /> (V7ee,4 ll se-}-6 c�s <br /> Nd-V 'fir hK 4n kit. 4 '') <br /> a I�� <br /> c'• Fee Rec: <br /> o• Check#:�D <br /> m <br /> r <br /> a <br /> m r- <br /> / m mn <br /> Date of staff site visit: //�/�� Init'als of site v' it staff: < a J U a <br /> / 03 <br /> c <br /> APPROVED BY LAND SERVICES OFFICIAL: �• DATE: SL ��.3 rn -. C <br /> n tV inn <br /> Page 1 of 7 z rr-- <br /> v g N <br /> Burnett County, WI Land Use Application—Rev 5/2023 .` . N <br /> inn <br /> r) w <br /> m <br /> 0 <br />