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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o <br /> CD I <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cp <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Ncrb O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Z>, <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 GI <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 t ; <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> ), Filling/Grading $150 Boathouse $500 14 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 2. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. & <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> z k <br /> Property Owner's Name: marVi J i-I 11 13 a> Try s-4- o INS <br /> a NI <br /> Property Owner's Mailing Address: ) .0 )O A- (..)$C-eole COI0. <br /> 52/6 <br /> City State Zip ° E N j'K I <br /> Property Site Address: 2 Y'73 r 4-nciti,r .Z,,�._ W.4) 5 4 r e.A.)/ s F.93 , o N ' <br /> Contact's Telephone Number: 7/.5-- u(7-0'3 Q3 <br /> 0Q o <br /> Contact's Email: IltA rV c_ 176'6..-'+r rna ). C e,w• n <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -- 1 <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov 0 °Q .Jao <br /> 1 <br /> Legal Description of Property: Lam-} I CS m 5�,5a k L 2d N 4 <br /> P P rty P 25Z 7 <br /> Section#: 0 5- Town#: 3N Range#: IS- W Town of: c+ F l(rife ''' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 3n,S3 7(' <br /> Proposed Use of Structure/Addition: Po l� 5(a.cQ - -roc D ^e .3 P C./4Anticipated Start Date: AT i / I S, ZUZcf (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (r <br /> = W oT <br /> Building Contractor: C-? -6 C Sewer Installer: aye r �Xcace„t y J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY rri <br /> o ` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z (L <br /> m <br /> !fle + a U se-�ba�S <br /> CI No-1- -It d ( Vatr tii ficb1+u�►an'S u tnl r <br /> Fee Rec: 15- <br /> °z Check#:7 c27 O <br /> Pc <br /> m <br /> n <br /> m <br /> Date of staff site visit:21I2-/2D2q 4-21 ZL Initials of site visit staffP t o <br /> r <br /> APPROVED BY LAND SERVICES OFFICIAL1 .{ DATE: 2123/2DZy 3 w <br /> ��%� Q. i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 1, E 01 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 2) < <br /> Page l of 5i EN <br /> Burnett County, WI Land Use Application-Rev 12/2023 <br /> LL. ) <br />