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LAND USE PERMIT APPLICATION — Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line <br /> CD I <br /> Permit Types and FeesPlease,check appropriate boxes) a <br /> CJ F <br /> V.Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Stru_ture $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <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 C- <br /> c <br /> Filling/Grading $150 Boathouse $500 <br /> c <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `< C—" <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r- 0 ° <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> _ ,� <br /> Property Owner's Name: I O1'n d- M I cJi• -U.e- 1-I-er r I = N ` <br /> Property Owner's Mailing Address: 41(el asa,r4 lei± Plvd, Mound_) MN 553�, i r . , <br /> City State Zip 5` <br /> Property Site Address: 59 p D Fl-3pa-rr''i sck- Dr. , D O(,(,�^ , Wi Jr 4'g�Q < ` <br /> Contact's Telephone Number: q 52. - "f l 3 -- ` 119 / Q <br /> d <br /> Contact's Email: 1 O fl a9. h-crreq m a,I I..con. <br /> **If staff has a question about this application,you 'ill be contacted via email. Make sure your email address is N '174 <br /> legible and your email provider will acceptteMemails from the following addresss: @BurnetttCountyWI.gov C °O N <br /> • <br /> Legal Description of Property: O7 -O /f-.-2-+I 15 -I1-5 15-L4.' -015 000 <br /> . N <br /> Section#: jo Town#: �I N Range#: 5 W Town of: S�/�/I�j .� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> — 0 G <br /> Tax ID#(1-5 digit number; found on tax statement): 22 9 5 -a - x <br /> b <br /> Proposed Use of Structur /Addition: m G l Cahn 11 -� F� (V <br /> Anticipated Start Date: r(L ,_o (Home Cabin;Commercial Business;Bedroom;Deck;etc.) T <br /> Building Contractor: C4- E VI/i,U2t„r- Dui 1OkaSewer Installer: F+crkl.f �S Id d Gray;1_ V'AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY v z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> 0 <br /> 0me-e-4 ail se-1-bstA <br /> D bwCi[in9 no-} --t -exceed 3 'C1,r rns Ste- 2y -Re <br /> a <br /> Fee Rec:3t <br /> b'"""" �J110l � GPd �0 l ef /�i /jlf r- Check# 447 5L <br /> r <br /> C Date of staff site visit: j g/2o2'1 Initials of site visit staff -+ k L ""i�nnnn <br /> C r inn. <br /> y <br /> APPROVED BY LAND SERVICES OFFICIAL � DATE:3/1Z/22- n oo C <br /> � � _ 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF F <br /> SIGNED PERMIT APPLICATION IN PLALN SIGHT v g cc <br /> Page lof5 <br /> �` JJ <br /> Burnett County, WI Land Use Application—Rev 12/2023 <br />