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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> s <br /> N <br /> Applicant Complete All Sections Below This Line ' <br /> o. <br /> Permit Types and Fees'Please,check appropriate boxes) <br /> d Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 m_ .� ' <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � C'.) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 9. <br /> Filling/Grading $150 Boathouse $500cn <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? <br /> In <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `• <br /> o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. .1 <br /> *. <br /> Property Owner's Name: n_r _ , <br /> N <br /> Property Owner's Mailing Address: Lko-1 OSjet-AA. A-u-k_ 5 _ S''�• c.u\ ►^'11) ,sc/ua I. <br /> n U • <br /> City State Zip <br /> Property Site Address: 3:,1 N i 0.cln101.,y n t.avvi, 9142A U Vi , 1.0'I' c-Li CS-1 1 0 <br /> Contact's Telephone Number: (.c..1- a :;- (,O' c-t .. CT <br /> NI d (Is <br /> Contact's Email: S . 2‘� ('h_S►�1. C;C�1'Y� c" <br /> f <br /> -�t.�-�,_ <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N '0legible and your email provider will accept emails from the following address:@BurnettCountyWI.gov <br /> Legal Description of Property:Sec:li'T IA 3'cK Rc,/H Loi-:I LS' V . L e <br /> Section#: (i Town#: 2 l N Range#: i W Town of: Oe-W e, E. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tt&system property page.* v' <br /> 70 F m <br /> Tax ID#(1-5 digit number;found on tax statement): ,3a.S$� oP n x <br /> Proposed Use of Structure/Addition: -i A <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) lV <br /> Building Contractor: Sewer Installer: W-...J <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6 z <br /> THIS PERMIT 1 SUBJECT TO ALL CONDITIONS LISTED BELOW: z <br /> This ?e..rrnm+ 1 -Ft)fW44�.e v�nclow ctl.-kru-hO1 O,n -F-l�..� lobs- -►r )i\ousre Itvt-t, r <br /> U.Qve,r house_ Vev-e,l gara,-e-© tox to u.02.r I euc.'. d,ec.J Q I D x to cnd ID' x2y deck < <br /> -C <br /> + of 9 <br /> On to _ <br /> tow tot( kieuck. Q �y"-kco reAccAno, wad ir\ -Nle. so.rre- -fao ert <br /> p, 5 act g`t0.1 "0 Fee Rec: �[2� <br /> anal add till 1' Hirt W6tt f S t0 ke 2�e l O °x Check#: 3 ` <br /> ►,Ouse 011d 4° 4Akt. la <br /> Date of staff site visit: 5f VZ'T 4 lD J5/211 Ini 'a1s of site visit staff: k_J-k1. 1 „ U <br /> �APPROVED BY LAND SERVICES OFFICIAL. DATE: 7//20211 r <br /> 0' <br /> -0n <br /> MI <br /> UPON APPROVAL: APPLICANT M ST POST COPY OF cn c -0 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 0 <br /> -0 0 Q <br /> Page 1 of 5 =. <br /> Burnett County, WI Land Use Application—Rev 12/2023 r, �,, ii <br /> J <br />