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• <br /> •LAND USE PERMIT APPLICATION —Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(P1ease,check appropriate boxes) 5 .A <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 ,� <br /> Commercial/Industrial Structure $300 i Addition/Alteration to Commercial/Industrial Structure $200 4 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 r (NU <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 t <br /> .Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(Sv)Structures $350 c i+ <br /> Filling/Grading $150 Boathouse $500 N It <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. la <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. s <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ..— , <br /> g <br /> 11 z <br /> Property Owner's Name: BCets+ }�Ak,S'IAS <br /> °o <br /> Mailing ,879 U-11 f N 5vtt 7 n <br /> PropertyOwner's Address: v1S+ I� 5 d <br /> Q City State Zip ° 4 , <br /> Property Site Address: Et1-Z RoAA Wel3sce2- <br /> 7103 ° C <br /> CD <br /> Contact's Telephone Number: 7V3'2-f5-32-W a <br /> d <br /> Contact's Email: Gre_n4 N A(S n ce qn a s-er ; I. coo,. ro <br /> **If staff has a question about this application,you will Ye contacted via email. Make sure your email address is N b _4 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and c °O J <br /> @BumettCountyWl.gov wo <br /> ALbErzT KNL k 15 Su,g DF �DEV ILS d <br /> Legal Description of Property:( p KE LOT 3 'p,,,Lk L E. <br /> Section#: 3 3 Town#: 41 D N Range#: I lt' W Town of: D.lt-1t d va <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* - H <br /> Tax ID#(1-5 digit number;found on tax statement): 14 16 1 o 5 <br /> -i <br /> Proposed Use of Structure/Addition: Re-Q1A►hJ €$ Willi St?t i'S <br /> Anticipated Start Date:14.` A J (Home/Cain;Commercial Business;Bedroom;Deck;etc.) e.� <br /> o V1 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> — Mk eA- oak Se-4 cac. -S ts- <br /> --This ?OM- `\S Daly -For g-i_ rtfutie-mk,n+ 4- StaikfS <br /> 0 <br /> Fee Ref I' 3 <br /> .'jXck- gear W Ot-t -r h(1ac - bt, rtmovtd 101 1241 )1D23 v Check#:�— <br /> m <br /> z <br /> I m l J <br /> Date of staff site visit: (�� I �Z3 In' ials of site v' it staff: < co I�,�,' <br /> -1 uuUAPPROVED BY LAND SERVICES OFFICIAL: Jv� r 'l DATE: ! /19'/2-623 rn C `^ <br /> cn `D 0 <br /> a <.3 r- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF '(3' a -- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Na ffil <br /> Page 1 of 5 < ' w <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 <br /> a <br /> 3 <br />