|
LAND USE PERMIT APPLICATION— Burnett County, WI a c"
<br /> a.
<br /> a
<br /> b
<br /> Applicant Complete All Sections Below This Line c c w
<br /> Permit Types and Fees:(P/ease,check appropriate boxes)
<br /> d
<br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 a
<br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200
<br /> XAccessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150
<br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 G� ' .
<br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < `
<br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o N
<br /> Filling/Grading $150 Boathouse $500 C
<br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r
<br /> "NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. b k
<br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees.
<br /> r ,�1
<br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 0. z `fl
<br /> o
<br /> Property Owner's Name: `j�Z� c5 - s� �
<br /> �• � % 1' oo
<br /> a
<br /> Property Owner's Mailing Address: g T) -3e-..5++-, ',..e -_, L , 13&—_,." w--. , M+� I.
<br /> City State Zip 4
<br /> Property Site Address: .e.g -)41 N &„► Ie.,, IV, , (:),..-,bl x� < <-J .3 S'4 R .�a o
<br /> Contact's Telephone Number: 9 S- d - 9 Q 9
<br /> Contact's Email: r .<� .--ru2, +'I' v � ,: �., 1 Q C_ • F.'
<br /> **If staff has a question about this application,you Rill be'ontacted via email. Make sure your email address is N ,o
<br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and cm,
<br /> @B urnettCounty W l.gov g.
<br /> b
<br /> Legal Description of Property: `1• E NJ L, (Lt F E �s)-1 ., T a !-A,,.,, 4" ,tty4,: % J,.„4 :.
<br /> Section#: S I to Town#: T'qb N Range#: a, 11 W Town of: l.), r-.,__ C4
<br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o
<br /> Tax ID#(1-5 digit number; found on tax statement): ' 4 S2 1 '
<br /> H 9J
<br /> Proposed Use of Structure/Ad ition: E -i - _..
<br /> Anticipated Start Date: c ' ��i i 4i`6 2 (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) c-E, _
<br /> Building Contractor: C---*'ar' Sewer Installer: `J 0
<br /> z
<br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY
<br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:
<br /> (Meek ail
<br /> I- sefbackS , _6 o�
<br /> oZ , ,c L✓t4.n ha�, -�.
<br /> y Fee Rec:/ #t"
<br /> Check#:9/3l5(
<br /> 19
<br /> 2
<br /> o
<br /> )�
<br /> Date of staff site visit: "1 ii 9la3 Initia of site visit staff: he <�
<br /> �APPROVED BY LAND SERVICES OFFICIAL: � [�cre DATE: I�0 3 ma-
<br /> ,--to y. Iiit
<br /> UPON APPROVAL: APPLICANT MUST POST COPY OF oor)`74o, co
<br /> co
<br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C .
<br /> 0
<br /> Page 1 of 5 1 Ca3. I
<br /> Burnett County, WI Land Use Application—Rev 3/2023 "
<br /> ))
<br />
|