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LAND USE PERMIT APPLICATION -Burnett County, WI c <br /> Applicant Complete All Sections Below This Line 0 CD• w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> d <br /> Dwelling/Principal Structure $300 A Addition/Alteration to Dwelling/Principal Structure $200 Pie _ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 of� <br /> F <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 '03 FD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o w as <br /> Filling/Grading $150 Boathouse $500 <br /> w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 R r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. I g' --. (1 <br /> • z <br /> Property Owner's Name: t: <br /> 0 (.� N Av ti.= 5 " — <br /> Z. <br /> Property Owner's Mailing Address: t .1 2_ 4 o Netm t re f -6 <br /> . n <br /> City State Zip ° <br /> Property Site Address: S)4/sit 1: ,ty ✓_ _,4,1 g t.J i o <br /> cp <br /> Contact's Telephone Number: (41.t 7 cS';_ ,d 1 7 7,S a <br /> C7 <br /> Contact's Email: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N —.I <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and R• °Q <br /> @BurnettCountyWl.gov w .� <br /> 1i <br /> F.Legal Description of Property: 14 454.) I - Al 0 VC)) Y[,U L i�'-Ir- f 5.o <br /> Section#: 1 0 Town#: `4 N Range#: d 5_W Town of: A &s 1L &AL -a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ' o <br /> L G <br /> Tax ID#(1-5 digit number;found on tax statement):_ --7 5 7 0 "-1 <br /> Proposed Use of Structure/Addition: e F r I b j." i/ r-tC. I ni a;L.p'C t T- ( ., (S <br /> Anticipated Start Date: ( 0 •— 1 — 1.. 7i (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) V' -►1 <br /> Building Contractor: Q t.�.) !U Sewer Installer: A-t_(_ y 'A P of t�-- 0 3 O <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Po <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - ' -L- CW. Se.-4-7&C, -S <br /> b '`Yc) Yo-{ 4° a uLci 2 bid-roDm ize% S -2 D - I i g <br /> 3"�'' '(' S4S-RAY) -ID 1_ Stry 1 Ltd 1,`-f 12.131 I -3 y Fee Rec: <br /> o Check#: 5b6 <br /> m <br /> z <br /> q Jj <br /> Date of staff site visit: ` I a/2oz Initials of site visit staff: T r— I l <br /> y� lcl a) <br /> fral <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: C //31 ZO23 COc r° U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y. r Fill <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . _ ' �` <br /> Page 1 of 5 .` <br /> Burnett County, WI Land Use Application-Rev 3/2023 <br /> L -J <br />