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• <br /> LAND USE PERMIT APPLICATION - Burnett County, WI c r <br /> ro <br /> Applicant Complete All Sections Below This Liner. c w <br /> Permit Types and Fees:(Please,check appropriate boxes) d tyi <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 P4 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 , - N <br /> C) G <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> f' <br /> Filling/Grading $150 Boathouse $500 0 <br /> En <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. $ " ti <br /> o <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 /> z a, <br /> 4(Property Owner's Name: 114 rn d�a k o <br /> o <br /> Property Owner's Mailing Address:1(?13 & Rd � seeon�r <br /> I <br /> 1aq3 � P(" r s C,fi� City State Zip <br /> Property Site Address: , p o G <br /> Contact's Telephone Number: 7/3 _88pZ— ()At P • a <br /> v <br /> M <br /> Contact's Email: ci r f)q ael 6) 0✓1 5 r). Co = <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and V °Q <br /> @BurnettCountyWI.gov cm 9.3 <br /> e GS //� 4� 8/18rZ "� f- G <br /> Legal Description of Property: 90 S P <br /> Section#: 2.--It Town#: 11-40 N Range#: /III W Town of: O cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N c 5 <br /> G <br /> a <br /> Tax ID#(1-5 digit number; found on tax statement): 3 a.? <br /> H <br /> Proposed Use of Structure/Addition: (i('ti.Q� VN - <br /> Anticipated Start Date: v (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� ��' <br /> Building Contractor: Sewer Installer: \o N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALLCONDITIONS LISTED BE OW: •�. •N <br /> (VCe%MQS7p/2.02...y �ifr /►�a (C. iv k i' 'r t,� <br /> ' m the So ovate / �'t�rwr'y ,, <br /> dt�,H S /'7 /w+f C4V'V/O u s 'Y`LA /N ZA Z /7 et N y /AA i�T7 94 77n n y Fee Rec: 1 _-- <br /> t l'/I d e ��e r"t.u`,Ll+e.d a f ,7' h IA-t.e • / c Check#: la7,G <br /> © 6iav' Ge_ Pio - he— LA S� u-Cr A aH 1 4 i17�7 <br /> a 7'o70n / z <br /> R31Date of staff site visit: Initials of site visit ff: <! - a <br /> ri <br /> ,+w <br /> $ 20zi� 4 <br /> h <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: I C N <br /> a N is <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF o — a <br /> orig a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Aj� Q an <br /> Page lof5 72 nri_ its <br /> Burnett County, WI Land Use Application—Rev 3/2023 d I f , l J <br /> -3 <br /> a <br /> i <br />