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LAND USE PERMIT APPLICATION - Burnett County, WI cr i <br /> E. <br /> Applicant Complete All Sections Below This Line 0. c 0 <br /> o. <br /> Permit Types and FeesfPlease,check appropriate boxes) e, c.)1) <br /> C7 <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 � <br /> (� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O\ <br /> i` Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 cu <br /> cu <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 0 <br /> Filling/Grading $150 Boathouse $500 .. Ilk " <br /> Solar Panels(Stand alone or roof mounted)- $150 Permit Extension(1 Year Extension-Allowed Once) $100 g. ' <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. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z`. <br /> , <br /> Property Owner's Name: W i L LA f 11n M 1 CM E I • <br /> a. <br /> Property Owner's Mailing Address: 9O 1 W ? i 114 (72c 1 k 2-, M i Jt 1-OOL.�'S iv J S cl-oO , w. ^C <br /> City State Zip ° "' N <br /> Property Site Address: '2438243 1 SIA1 (4>Li,'i fZ.b1 QbrN'5t w i 5--? o E <br /> C <br /> Contact's Telephone Number: (' I Z. 6 f 314 3 ° <br /> d <br /> Contact's Email: N A M l CA-1 S (;)_, Co AA 41 I✓ • L'0 1\ <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: @BumettCounty.org and E. °Q <br /> @BumettCountyWl.gov <br /> P. <br /> Legal Description of Property:\EE. L otEE A-D P -Cb VOy i ?'EK VILLAGE LOT 79 5_. <br /> Section#: 13 Town#: `10 N Range#: 15 W Town of: .-lAcC-if.fo lv (4 J... <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d _ <br /> uvLA <br /> r�.�(D W C7 <br /> Tax ID#(1-5 digit number;found on tax statement): 1� <br /> � Q <br /> Proposed Use of Structure/Addition: NGM r` <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) F-,- <br /> Building Contractor: Sewer Installer: 3 <br /> z !. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> M au k4496( k <br /> eitAtro jitAi asicli4;of\ 4 +tAit aec,k co.c1 <br /> --ntl.,‘ pakt.ti- l <br /> Fee Rec:,;?1�l— <br /> oCheck#: 'r?Z <br /> rri <br /> v <br /> Date of staff site visit: VS/ZZ/ Initials of sit visit staff:4 I x j L ",'� J <br /> trifit <br /> APPROVED BY LAND SERVICES OFFICIA . DATE: >, .' <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT V 3 N <br /> Page 1 of 5 ri <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 " T:7— " <br /> a <br /> "t2 <br />