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• I <br /> r <br /> ' LAND USE PERMIT APPLICATION— Burnett County, WI N <br /> Applicant Complete All Sections Below This Line to.) <br /> Permit Types and Fees fP/ease,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 v <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 i NI ' <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 h. c <br /> .-: <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 Z t\ 'I <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ' o ic) <br /> X Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 b �� <br /> Filling/Grading $150 Boathouse $500 <br /> F. 9 <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. <br /> -d <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b FL.z / w <br /> c <br /> Property Owner's Name: �c..5V)Y . t#kc,an 1 '\, <br /> Property Owner's Mailing Address: S c71, 'V Co ' r 1 fr. 0 1/anie t t,t y Q.": S'1 c? . r; <br /> City State Zip <br /> Property Site Address: ,' -1 <br /> Contact's Telephone Number: G ( ,). —(A S .-A 'i Q <br /> Contact's Email: 3 ;-te.a A"..L__Rc k.c I : co l <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: (iiBurnettCounty.org and <br /> !liBurnettCountyWl.gov ac <br /> Legal Description of Property:L-O f' LI CS i(n 3 3`-10 VOL I b?i I S E. <br /> Section#:5 IS Town#:Ty b i\iN Range#:R I S 14 W Town of:`j,C4c-seems <br /> *attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* � o' ' <br /> F n <br /> Tax ID#(1-5 digit number:found on tax statement): s3(pr ) 1 1� <br /> H <br /> Proposed Use of Structure/Addition: t,, rt Pt{ ?,„*',`s <br /> ,� `� \r1 <br /> Anticipated Start Date:�r•'t (Home Gabin;Commercial Business;Bedroom;Deck;etc.) O ' <br /> Building Contractor: A.V)(1 Vv <br /> �F,, Sewer Installer: �' <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i6r4 l'5 /5 t� 40ZiiS PC,r'w, <br /> e, , T {ter e- /-Q 4o 4S <br /> ' cvv imAe / in frilm -Z3 -49 <br /> ��cc�, <br /> Fee Rec: /23 - <br /> d Check#: /0, <br /> r <br /> 6 <br /> Date of staff site visit: 12/7/ZO Z 3 Initials of site visit /' < , '�L,j.) . <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / /L.9L3 CA . in L <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF 4; 111J11 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT fl <br /> Page l of 5 - 2 <br /> Inril <br /> Burnett County,WI Land Use Application—Rev 5/2023 d <br /> L J <br />