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LAND USE PERMIT APPLICATION — Burnett County, WI a co <br /> b <br /> 7 <br /> Applicant Complete All Sections Below This Line �' c w <br /> Permit Types and Fees(Please,check appropriate boxes) e. /�. <br /> C c'� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 PIO <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c ID <br /> Accessory Structure(Garage,Shed,etc.) $150 •Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° CO <br /> (.._ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o c w • <br /> Filling/Grading $150 Boathouse $500 N <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. t <br /> o*Communication Towers,Camping Permits&Signs require a different application.form;see corresponding application.,and fees. <br /> I*items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ' <br /> P Y El I�Zi 'o-e.'I—v1 (' S IV I�— <br /> Pro Property Owner's Name: Q j� o <br /> 1,1 UN <br /> o <br /> Property Owner's Mailing Address: ID K 3174 s+1 .4- 5 f\J V'V 'Pm b <br /> f/+ c City State tp 4 <br /> Property Site Address:LQ D2 ?t Vl I-j ,R.J. l Wojs�"t/�/ YIN S (,Q o'l ( o <br /> Contact's Telephone Number:952 ez_ W - 5 il <br /> Contact's Email: tAtch C.f V�j( �1 (� -\ �I 1 <br /> **If staff has a question about t is application,you 41 be contacted via email. Make sure your email address is N ,b ,--t <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and c °Q —I <br /> (ajBurnettCountyWl.gov I c.N <br /> (Nit-- 5-- d LA Legal Descriptionip} of Property: U 4` 2 .S� V 2) ? 1 ( 31 tit 3) N W •;S't) —4 , <br /> Section#: 21.0 Town#: gl N Range#: ke W Town of: me e_Vv c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N o x ivy <br /> Tax ID#(1-5 digit number; found on tax statement): 1 2_0(3-1 i` <br /> H <br /> Proposed Use of Structure/Addition: 5 kS`t.i 5 cL. -C. , ,N <br /> Anticipated Start Date: F, Is- , 24)-2.--72 (Home/Cahin ommercial Business;Bedroom;Deck;etc.) <br /> Eluiid;ng Contractor: iL /1 t6 c L,LC, Sewer Installer: Imo! <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • ►\A ca.UL SR.- toCka S 1� <br /> .Q Q k <br /> • <br /> • 'VAT -Ct/ 6_,Lv Lb.-✓1 V`G.� 4"tTt� x FeeRec:t' <br /> d Check#: �� <br /> • Qr�vkl�S-4- \at VI'' <br /> �w¢. m <br /> t 12023 8 r- t <br /> Date of staff site visit:7/170,23 (( Inir Is of site vis' staff( �/ 7) Q, c_ (� <br /> APPROVED BY LAND SERVICES OFFICIA7 DATE: D Ih/ZOZ3 i <br /> < V�' ' <br /> W <br /> p0 CO <br /> Page 1 of 7 - -a o <br /> Burnett County, WI Land Use Application-Rev 5/2023 " w <br /> J <br /> m 2) <br />