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' LAND USE PERMIT APPLICATION — Burnett County, WI a r <br /> E. <br /> Applicant Complete All Sections Below This Line 5' c 6,3 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> 74. Accessory Structure(Garage,Shed,etc.)3CV$t5tT Addition/Alteration to Accessory Structure $150co <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> co <br /> Solar Panels(Stand alone or roof mounted) $150 r Extension-Allowed Once) $100 ? <br /> NOT _ <br /> E: After-the-fact permits(permit acquired after construction has be un)may cost up tothree times the normal fee. <br /> *Communication lowers,L ping ermt s igns require a different application form;see co p t app tcatton,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o' 1' <br /> z <br /> Property Owner's Name: C—(/' 1 IQ' o o q <br /> (� �- 5 w <br /> Property Owner's Mailing Address: G l D hn.1C1 ik,li1�,(A i IL. L. A4 ) F <br /> City State Zip E 00 <br /> Property Site Address: ZLcctrt (_ V l el\f 5 0R-£4..1 b l.91. 51 �0.-- <br /> --_, O n <br /> Contact's Telephone Number: ,5 1 4J k, e0 a. <br /> kL b d <br /> L P Contact's Email: 17 ' N( i&7 3 • 0.�l0- CD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b ^� <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5, °0 N <br /> @BurnettCountyWI.gov al <br /> 0 <br /> Legal Description of Property:5CC `if P• ...D <br /> Section#: q Town#: 3q N Range#: 16 W Town of: Ke s 4 T'l 7. v) <br /> 7 . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0-3 <br /> 1 5 <br /> Tax ID#(1-5 digit number;found on tax statement):_ 12 7 443 <br /> Proposed Use of Structure/Addition: <br /> N <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 31 J <br /> Building Contractor: 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: 1 1 <br /> 0 + 01,1 �-1-bc s. 0 -b .4- DC-k S i ale. St.- . <br /> 2 +- —it be u - V kU m. hLdal4 `lY' r <br /> x Fee Rec:P <br /> go is ?air e l 1 S wl ct td Q 4- 15 /0 1 AfTeyviouS S u.--(-u.c.e. . P01/.1 4 Check 07 <br /> rm <br /> -R r Q l yvtior) vl. mil( ref GU r Q, ltil,i-l-1 o Nl z <br /> �7 rrivrn <br /> J l ) 1 <br /> Date of staff site visit: ` /i Z/202 S Initials of site visit staff: xi <br /> APPROVED BY LAND SERVICES OFFICIAL. DATE: S f( /2a2 y y = C U u L' <br /> � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z A N , <br /> �i, <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . m= N <br /> Page 1 of 5 m 3 `r`' illni <br /> Burnett County, WI Land Use Application—Rev 3/2023 v R. <br /> );I <br /> -o <br />