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LAND USE PERMIT APPLICATION — Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 v� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 , i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c , L_ <br /> )( Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 V' <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . si <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. $ S <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. ...4 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' "' <br /> z <br /> o r <br /> Property Owner's Name: 3 OS1‘ 1'1Ut; Nka1 0 <br /> a. <br /> Property Owner's Mailing Address: l Dl )c)3 C,c L L4 Ice\),t I i� �C`-N' n 1 <br /> City State Zip ° cn <br /> Property Site Address: ( 5 4$ (-N-1. —/d S i(Ci ukz .j43-7 a o <br /> Contact's Telephone Number: a a� L)S $ N co <br /> Contact's Email: P ILIA b k.1 e1&5r-kc;i , ( 0„,, E <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,ti <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and , °Q <br /> @BumettCountyWI.gov aQ N <br /> Legal Description of Property:L S ii� � ��� �Q as P 3 3L1 c <br /> 6`fi <br /> Section#: Zj 5 Town#: '°I N Range#: �,, W Town of: PI t a€ O vl <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F ,HTax ID#(1-5 digit number; found on tax statement): 3 `�` �j \ "1 . 5 <br /> f H <br /> Proposed Use of Structure/Addition: DecK A- PCd11-icy W k w <br /> Anticipated Start Date: 1/43,.(.1(A (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> (Z4C- LAW c:Al- (: ¢1e. " ((Ai id --.0 i N <br /> Building Contractor: 1-}t x.c,..;at.r — '0 is K Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY O q\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> o1 l' / Le_ ,s+s,�//�DN s>��� 74,,,k .dy //�z3, <br /> Loch GGt a'/%t 7v <br /> x Fee Rec: f.CD <br /> Check#:CA4-It- <br /> om <br /> z <br /> 0 <br /> rr, <br /> Date of staff site visit: /�7ZeZ3 Initials of site visit staff: /// < 0 <br /> ____APPROVED BY LAND SERVICES OFFICIAL: /u v —4--+---- DATE: 7//0,0 2.•3 a <br /> g)w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 5 Z <br /> r C� <br /> m w <br /> ITN <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT cz <br /> iai <br /> Pagelof5 ril w`` w <br /> Burnett County, WI Land Use Application—Rev 3/2023 v a) <br /> 3 �. J <br /> J <br />