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. j / .t J' % (all, <br /> LAND USE PERMIT APPLICATION - Burnett County, WI cr <br /> . n. N <br /> Applicant Complete All Sections Below This Line 0 c w <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) C7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 i <br /> ccessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 g' ♦ <br /> Filling/Grading $150 Boathouse $500 < <br /> cn • <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> b <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. 1D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g' 'x. ri <br /> o <br /> Property Owner's Name:-----NC-- d(f ,} / PJ o <br /> Property Owner's Mailing Address: r ) &')( fCi (0.1-,5Y437K ea: ca.g9 5 1 n <br /> ,� City State Zip E <br /> Property Site Address: gib 6 G,may, A/, 0 Wfi e i '`_A 1-01 /j 4/- '- 3;=> .o y <br /> Contact's Telephone Number: 6 O 2 r e/ 7�x? E. <br /> Contact's Email: 4.SA 54 rip 074gm C-- "iA V <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 00 00 <br /> @BurnettCountyWl.gov <br /> p�� �,�,,l J d <br /> Legal Description of Property: d1( 4 ! / 0 r 1/a lV ' ry WE TV w Cw•tpE5mT j '. <br /> Section#: 2r 1 Town#: 37 N Range#: 17 W Town of: t WCOLN E4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* , H <br /> Tax ID#(1-5 digit number;found on tax statement): i 69 36 ,v\I <br /> Proposed Use of Structure/Addition: f S Tt'Rn6E- <br /> Anticipated Start Date: i, "16 °-.2.j (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W <br /> Building Contractor: 04.//(1.4k Sewer Installer: j <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT S S�7BJECT TO ALL CONDITIONS LISTED BELOW: <br /> gI 1 hte-t- a 11 54 -„S <br /> iCivo+ ,6( 4,4,44 A h hoi#1244-4C 611 <br /> y Fee Rec: /5 <br /> o Check#: 3/14/ <br /> m <br /> z <br /> z <br /> u <br /> 2 <br /> Date of staff site visit: �,1f 111`/v1./ Initia of site v' it staff: li✓E. <br /> n <br /> APPROVED BY LAND SERVICES OFFICIAL: • f DATE: 10-0/001'3CA M <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <03 0 <br /> Z gi c- M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT j o () l=J(� <br /> Page I of 5 a)• w <br /> Burnett County, WI Land Use Application—Rev 12/2022 0 g <br /> a LL J <br />