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LAND USE PERMIT APPLICATION — Burnett County, WI a 0 b <br /> N <br /> Applicant Complete All Sections Below This Line a g w <br /> a <br /> Permit Types and Fees;(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200CD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 \Accessory Structure(Garage,Shed,etc.) $150 X Addition/Alteration to Accessory Structure $150 i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> :7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °< i. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r \ <br /> Filling/Grading $150 Boathouse $500 c <br /> m <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. '5 <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Q ,z 1 <br /> l o <br /> Property Owner's Name: //i,r1�L! _S f� `irt.� " <br /> // a i'. <br /> v8Dtr 3�v t��N b �� �i 5 ��® <br /> Property Owner's Mailing Address: �l .. <br /> _ J/ / CIS), JJ State Zip J <br /> Property Site Address:. 6f 28 7-",i,©O� 4 j< 27 r 'O,cw/.'v r'1/ (A)/ o E <br /> 5T 3/7 <br /> Contact's Telephone Number: 9 pZ 0— 7/—0���/ ` n <br /> Contact's Email:, , //y„$te"✓,c9/x Cc' ,119•'l r re- n <br /> **If staff has a question abot t this application,you will be contacted via email. Make sure your email address is N ,71 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and <br /> @BurnettCountyWl.gov °° L <br /> �y ' � o Jr <br /> Legal Description of Property:t Q 3?�— 6 1 6 " Q a,0 °X) <br /> Section#: I 7 Town#: V/ N Range#: /.5—W Town of:514-i/5 tA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* .-3Tax ID#(1-5 digit number;found on tax statement): 15? <br /> V' <br /> r2 n y -3 <br /> Proposed Use of Structure/Addition: "CC e S" D �,J idA Site r.✓>ke'Py1 n A7� �/f5, /-�A1'' e•v `, <br /> Anticipated Start Date: .Sfr i N4 aQ 3 (Home/Cfabin;Comme ccial Business;Bedr6onu/Deck;etc. <br /> Building Contractor: ..57/e, r in 4.-ke root 4 AV Sewer Installer: UN, Y <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> O IVc 49( httiltait 11.,►b, i'an �i <br /> a 5)04-i- 5cffic-r.ok bc..-kem wa5 404- 4wts Jue "ID -6 J <br /> nte5 S oe15•b• t 4v ►Net 6�1-, SC`�AGk i *oh. i' Fee Rec: /5 <br /> 7, <br /> v e- ail 5494,46 <br /> r l_ 46 o Check#:73,7) <br /> 1177 rrl <br /> z <br /> o Jl Jf <br /> Date of staff site visit: 1 f I ? 3 I itial of site visi staff: HE* k < r— �^ J <br /> APPROVED BY LAND SERVICES OFFICIAL: . DATE: I )'ni ` tl u 11 <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o z ( <br /> z a .. UBl1 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT co <br /> -< Qc N a <br /> Page 1 of 5 < 3 w <br /> IM <br /> Burnett County, WI Land Use Application-Rev 12/2022 0 a <br /> ro <br />