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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c' w <br /> PP P o CD , <br /> 'Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <br /> Commercial/Industrial Structure 300 Addition/Alteration to Commercial/Industrial Structure $200 \0 <br /> cessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> irs atio Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campro Structures $125 WI State Statute 59.692(1v)Structures $350 W <br /> Filling/Grading $150 Boathouse $500 <br /> C4 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0 <br /> IltunTF•A r th fart narmits(permit acquired after construction has begun)may cost up tothree times the normal e $ k <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. t" b j <br /> "' 10 <br /> Property Owner's Name: a CR GtGif f e.,V 0 i t- <br /> o <br /> Property Owner's Mailing Address: ZSS"1 S S 1 val Vv QCd S Tv1 VIII,Wek w I 9-1 D 13 1 n <br /> City State Zip <br /> Property Site Address: 41 <br /> Z. o LT <br /> CD <br /> Contact's Telephone Number: 1 IS (p IP-I tA5 ov 1 tS-so,..I CD <br /> Contact's Email: (3 VA910/ Cat 1' 1 00.(Gf'l K(1,3`{w�6G CLs1'( G :: <br /> **If staff has a question about this application,you will b coitacted 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 5 04 <br /> @BurnettCountyWl.gov v <br /> ` ' j C <br /> Legal Description of Property: L 01 2 CS ' 1 3g84 v l`I (N�' N W gd. <br /> Section#: 21 Town#: ?)9 N Range#: .tp W Town of: Met an C,, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Ve) c <br /> Tax ID#(1-5 digit number;found on tax statement): I21LiC1 i d <br /> 9 � <br /> Proposed Use of Structur /Addition: ?CAC. Slwl.a 3 ' 3 <br /> Anticipated Start Date: Avv%1 \ 4-3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W f•w <br /> Building Contractor: SI-tF Sewer Installer: CA4VAttj LY.IST1 11�� „_p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z ?THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 10 Ylee4-- ali 5et,j,44 ,_ <br /> aWoo 51i ck✓ld PO l�'0 -t'`'/e_p,-1- a�+�� il eeLd - - .=f4- / c�b t)�� Imo' a©�.�j t >C Ilo✓/YtI?i,Tc v, Fee Rec: !�� <br /> ?eon; I,. c Check#:_s-__ <br /> 61 tall + ChaU/), A4- bc 04 <br /> �,J / �� Wi <br /> V�Date of staff site visit: LI/ 1 !� t' 1 of si vi it staff: < �,^ i. <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 54?3 a o0 3 u u U <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r�7 <br /> z CDc..= 4 (� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ., r� <br /> • Page l of 5 Mf w <br /> Virg <br /> Burnett County,WI Land Use Application—Rev 3/2023 v— <br /> cA <br />