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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0 cn w <br /> a ri <br /> Permit Types and Fees:(Please,check appropriate boxes) � '(J <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 �' \p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ' - 0 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n <br /> v Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °. P <br /> " Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o VI <br /> Filling/Grading $150 Boathouse $500 f' <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 UV o v n <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `7 <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. �� <br /> Property Owner's Name: - 4-C1Cit6.. < rc-' Ac c ei E y,"4F_-_e + o • <br /> % <br /> Property Owner's Mailing Address: 333(p 4\`i ,'�ck Nam "iHfi°►.��t `^'y1� n <br /> City State Zip E <br /> '-�Sl3 l�.x0Sen eery , :. ti s'�C S. y <br /> Property Site Address: �_ <br /> ` ,^, // �� CD <br /> c <br /> Contact's Telephone Number: (12 a L 3 VI <br /> w d <br /> Contact's Email: P�c�k e Y k C%c"am ('r�.CQvv, <br /> **If staff has a question bout t application,you will be contacted via email. Make sure your email address is N - <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 5 °Q <br /> @BurnettCountyWl.gov c <br /> 3 Csm v 3 F• ). ( ►,,cam,, L4 3) o <br /> Legal Description of Property: 3. <br /> cs' <br /> Section#: D(0 Town#: Lt i N Range#: I W Town of: ... t S c u) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* E K <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> y � ' e <br /> e <br /> Proposed Use of Structure/�ddition: <br /> Anticipated Start Date: U. a.t (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) rt. ' <br /> Building Contractor: Sewer Installer: OJ IA <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 /> 01))ee-i- a(I 5e-S-bkcA5 Lit <br /> w, L'i.et-,;; 64-ic' tic'(ess C' rlr of j.;ll 07Ir( b 3-.T-L i) .j-2 <br /> `,r` l/,yE (`c; r,A CS. z Fee Rec: I ZOO <br /> t o Check#: 1l)11 <br /> m <br /> r- <br /> a <br /> z <br /> o ,_ <br /> J <br /> Date of staff site visit: ,,/1 9/ Initia of site visit staff: rr, <br /> w Ind <br /> rnn Q lltltJ <br /> APPROVED BY LAND SERVICES OFFICIAL: [% DATE:5//) i tr coo W <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o C <br /> z m p p <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTrli w C' <br /> Page 1 of 5 ((ifil <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 �� JJ <br /> -.3 <br /> a <br /> b <br /> American Family Mutual Insurance Company,S.I.&Its Operating Companies,American Family Life Insurance Company,6000 American Parkway,Madison,WI 53783 <br />