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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> N N N <br /> Applicant Complete All Sections Below This Line a- CD 4+ <br /> 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) e <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �V.) i <br /> V Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> ) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° N• i.. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 v <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. <br /> F N <br /> -o <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. 9,, ' <br /> z II <br /> 0 <br /> Property Owner's Name:GL/ / ORTA�/c if /- !A t1 -n <br /> !! s <br /> 0 <br /> a. <br /> Property Owner's Mailing Address:c2f36.713 (J}- i L.E.- tt �7 'DA (1IJP,L1IQ�/ LL . <br /> )i 3`f1))3. n S <br /> City State Zip cp <br /> Property Site Address:,:, 9,;z 3 7 /-1A/V)( )M L.A KZ- 7-le I LAI Xi / o F.Contact's Telephone Number: 7/5 -" 5;' 763�5 (yam ET) 7/5 - "�/�/—/65/ C- ;n }} 0. <br /> CELL) d <br /> Contact's Email: LO H}VlA/L i (23-MR /L. . CD <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: @BurnettCounty.org and = `� <br /> @BurnettCountyWl.gov RC;o2ERCx�," A. <br /> z.02 g <br /> Legal Description of Property: S Y2. FIE) �&s, �i..) (td/ 1`SM/VT ' , c?6a ) 4. <br /> Section#: O( Town#: k) N Range#: .i W Town of: SCr)TT cn <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax sys r page.* m <br /> TA I/..) (A) O <br /> Tax ID#(1-5 digit number;found on tax statement):p 7 •-C� <br /> . -�c) _/'/-£ - / 77627 <br /> Proposed Use of Structure/Addition: (.77-A RRCir~ `STD)i?F Gt6- J <br /> Anticipated Start Date:S'PR/N&/3L/N 119,tl2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> .2v03 W <br /> Building Contractor: ! (j C.L,f-) Sewer Installer: /\//A ` 1 <br /> z �1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x <br /> THIS PERMIT 1IJS SUBJECT TO ALL CONDITIONS LISTED BELOW: — <br /> 1 Vn et+- 0. (t Sc.G $ r- <br /> ®lm- &( ktrK II <br /> z Fee Rec: `�ao <br /> o <br /> Check#: 27c, <br /> m <br /> r <br /> a <br /> z <br /> 1 <br /> ^� U m r J—1_J <br /> Date of staff site visit: 3'�` I ai Initial of site v' it staff: T ►/ < r + <br /> m <br /> ff <br /> n 3 <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:3l a a3 cn CD co X , <br /> a ‹.3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o gl 0 ff <br /> z v o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT rn CIO <br /> Page 1 of 5 rrl CD <br /> Burnett County,WI Land Use Application-Rev 12/2022 0 . , <br /> a <br />