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. LAND USE PERMIT APPLICATION -Burnett County, WI r <br /> a <br /> Applicant Complete All Sections Below This Line w <br /> Pe _ - •d Fees(Please,check appropriate boxes) <br /> C <br /> '� Dwelli •-.,9 ncipal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 I <br /> `� ommercial/Industrial Structure/ $300 Addition/Alteration to Commercial/Industrial Structure $200 I, :,':Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 c� ^ <br /> P V� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o ` <br /> Filling/Grading $150 Boathouse $500 1, <br /> i � � <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 M <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <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. <br /> a fir, <br /> Property Owner's Name: SuSCx v\ C R cto, .N !�`� 8 <br /> 3 I <br /> Property Owner's Mailing Address: A-1 10 G}LA £CCC '4 i ,f' U it 51-tcs E.1 'n N <br /> E ,n <br /> Property Site Address: *nc c� d.;rss `'S ' Sew �L rty State Zip1 <br /> < <br /> "20?o c,iy/�� <br /> Contact's Telephone Number: Ga.D1-'�q�_k�, �{ N � <br /> Contact's Email: c--r St.:'-n-- -4:::k G osPrY \• ClifxY1 J <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: rBun►ettCounty.org and B d0 <br /> �(OBumettCountyWI.gov Rec.oci1ci czs d <br /> Legal Description of Property: 1-CY1- c (DC CS" t-tC)l41 ,_,,` k cif ' '-.)G `tu lLrd 1 �. <br /> Section#: Town#: 39 N Range#: 1`- W Town of: R u�k 5i`' c- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* '� j o <br /> Tax ID#(1-5 digit number:found on tax statement): 354-11 <br /> Proposed Use of Structure/Addition: ShC- -k- --4(--t M CP.4A-ko--\ C.>c \^` / lb <br /> Anticipated Start Date:C S `SctIr- a� e- r1i,, �fome/Cabin;Commercial Business;Bedroom;Deck;etc.) 1 V" <br /> `l <br /> Building Contractor: i(PA l{,-u,Cr.C Sewer Installer: rYl 4K Si-i C. R— •• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �1� t � <br /> -mil I v�f 15 pf/'1�w t t� /t5 �o d' ®r`� �I 4/�� S/f D� Gt�li1 14 ' <br /> lit'Q S �G�`t ve4tt c4 1^v�P�t� o�u/�l� a u lit �. / ? 9 g'• s► <br /> -- it o 14-/4_C t 1 c c 1 02?(.//0 i� P�" `I 44OIT'�SO�. . AFee Rec: N/� <br /> /V o 74- 79 c / "0 owJ /f1 e'' S�/U-20-Z.Sr, 64 Check#: /(J/f¢ <br /> tYi <br /> r <br /> a S `l — <br /> Date of staff site visit: #4/Z01.2— Initials of site visit staff: t"i ' " <br /> / nip\ � � Z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 3/2-7/ 20 L3 9 �\N A <br /> T- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF � ,.- <br /> `� Q CI \ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a �_ <br /> Page 1 of 5 k <br /> Burnett County,WI Land Use Application—Rev 12/2022 d k 4 �(* <br /> i <br />