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LAND USE PERMIT APPLICATION - Burnett Count, WI a ' t� <br /> b <br /> Applicant Complete All Sections Below This Line o cn w <br /> M. <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 ,, Addition/Alteration to Dwelling/Principal Structure $200 2. <br /> 0 <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 o <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk uJ Bunkhouse $250 °- <br /> Driveways/&Campground Structures $125 / WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> cn <br /> v <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> iv <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> -o <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. m <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o -. --11 <br /> Property Owner's Name: ilYc'c M H-e__-( //c:{yt r i c,,k o v <br /> /� n. <br /> Property Owner's Mailing Address: /3 27 e!1 d;,,`.; , 'Teo� , L 4), i3O --y 00 ) w <br /> / / City State Zip ' c' 5 <br /> Property Site Address: 6 3 6 3 e,e' '/e Vd 0 m ivikry w; S' 'F' U o FA <br /> Contact's Telephone Number: <br /> l 5-- 761 /v-6 N _e N <br /> L11 // W o <br /> Contact's Email: I t/g,A,J�'Lck-1 /'.g-Q sp et d i vl y se ly /4/4`r( . C r't- `' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N -o N <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °' <br /> @BurnettCountyWl.gov ca. 1 <br /> Legal Description of Property: GTT / C5-ir1 �j'3O V 2 ill()f' ZE'74' 5zy 52• CT O <br /> Section#: O Town#:T t O N Range#:/e(6 W Town of: irl1R x✓c - 6 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* O o ' <br /> N N e <br /> Tax ID#(1-5 digit number; found on tax statement): /2 '2 5 3 <br /> Proposed Use of Structure/Addition: G y <br /> 'U i'5+ . <br /> N <br /> Anticipated Start Date: J LAN C.- l (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: -e- ,'-5 if)�.5 Sewer Installer: A/ l/J <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> -uOilt , bunklINAI-f_ aer-e-fanite-r1-1-. <br /> N bc r = Fee Rec 375 <br /> ' pQ� = Check#: Z <br /> I WADI-DI- XX to 0 cc��f3 of ct-�c hit-e (S1N-2b-27Z) rn <br /> z <br /> VA <br /> KT- O JDate of staff site visit: 202-3 Ink' is of site v' it staff: < ,v <br /> EN <br /> APPROVED BY LAND SERVICES OFFICIAL: iiO4 ATE: / I / 2-623rn fa <br /> rn <br /> H m co� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° y w � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m ,3 N L- <br /> n (Jo <br /> v <br /> Page l of 5 < 3 EN <br /> Burnett County, WI Land Use Application —Rev 3/2023 0 1 , �J <br /> a <br /> 3 <br />