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LAND USE PERMIT APPLICATION —Burnett County, WI a g <br /> Applicant Complete All Sections Below This Line 0 0 w <br /> Permit Types and Fees:(Piease,check appropriate boxes) a <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 \0 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) & $) Addition/Alteration to Accessory Structure $150 t g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° A ` A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r"' lv <br /> Filling/Grading $150, Boathouse $500 o w •� <br /> 2 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . p <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. (� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' <br /> n ! <br /> z V„ <br /> o <br /> Property Owner's Name: t t rtC- 0 /3r ie,L‘_ c <br /> 0 1 <br /> Property Owner's Mailing Address: S .3 Z- ?1 /C /Oc11 Q, F,11uz,d m Al 5-5-6c73 <br /> City State Zip 0 <br /> Property Site Address: ,;_S /,,,2; gi,Z, L 6 ea.` f-r.t.4 ( o y <br /> Contact's Telephone Number: 6/02` 0- d.,f'T� o <br /> a <br /> d <br /> �)h �7 )Contact's Email: i <br /> , C( /t G t'/d c7 I'A'"**If staff has a quen about this application, ou will be contacted via email. Make sure your email address is N ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °4 <br /> @BurnettCountyWI.gov 00 <br /> / d <br /> Legal Description of Property:/5)/a / ,-,Ld" 4 >re 5 L c 1 _ 3. <br /> Section#: 457k, Town#: `//// N Range#: 17 W W Town of: 5 cc_.,r S '7 v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> W <br /> Tax ID#(1-5 digit number; found on tax statement): _2 S 66 <br /> Proposed Use of Structure/Addition: 5 c. ; c'oti- ,,,,r-f%�... <br /> Anticipated Start Date: / ,.2 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v 1 <br /> Building Contractor: C) LA-1/tif Sewer Installer: /VA (/) Z\ <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL Ir CONDITIONS LISTED BELOW <br /> ) yeei— ail s 64 ,te s. 0 rvo“-er ka. ti� hh,b,h-fi'°'1 <br /> / .....1 <br /> v ,ftei 0(4.64- be. cc_,,,? <br /> c_3,- ilecck 4 6&-ay <br /> ✓e 1 x FeeRec: 0, <br /> �/ o(4 O✓� (4/h P/ (�le4 GCC CS S O� per/44- 5. Check#:3 4� <br /> P 1 or h - <br /> rri <br /> tafs cons bmieS. u'',, C e(h'11eeC Cj rV,. My- v � � <br /> iv <br /> Date of staff site visit: 2-1 <br /> 7" )4?'3 I itials f site v' it staff: H / x a1511 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/3/?-3m coc m 0 <br /> CO <br /> cn < 3 CD <br /> ry Hi} <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z a o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 w <br /> iiIrd <br /> Page 1 of 5 < �� <br /> Burnett County, WI Land Use Application-Rev 12/2022 - <br /> ..j <br /> a <br />