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• <br /> LAND USE PERMIT APPLICATION — Burnett County, WI € ro r <br /> 5: 1 b <br /> Applicant Complete All Sections Below This Line 5' w <br /> Permit Types and Fees(Please,check appropriate boxes) '4,- i p <br /> XDwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ri <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 �Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 E <br /> `NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ' U`t <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. i <br /> z <br /> Property Owner's Name: }Q '�' -``� c i c " <br /> Property Owner's Mailing Address: tCICSaU - 'J`t vA�'e ` �� lac_.,1 \S hN COA 4. <br /> P rtY g �S� `� Ci� n `to0 ti O <br /> Property Site Address: \\eck VOr 361`L gti`n if1l�) 0,1,;ct City State Zip 2_ oF. "' <br /> °Contact's Telephone Number: 7�3 --(^!\1-01 C-:> <br /> � v <br /> Contact's Email: bU.uS 01000 C l c lt:0, ("'R <br /> UN <br /> **If staff has a questio about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and ?' 00 <br /> @BurnettCountyWl.gov c\ci:Ac,,;� po v-,C� a().-O '\ Q l o `e r ,gyp* (9 I-Us\ at) W <br /> Legal Description of Propertyc C uC't t\�� 6e-�r Cc;n im &NI W &C \ t^S us-v e ‘n <br /> Section#: 1 I Town#: LI 0 N Range#: ) 5 W Town of:%.014.,,S C " ' -=' ;1 c, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C. o <br /> • <br /> Tax ID#(1-5 digit number;found on tax statement): 19'}I 79 ',DO -.1 � <br /> Proposed Use of Structure/Addition: Noce_ I C�`c 1 ti -a <br /> Anticipated Start Date:S uAt A QL r 'f`Z(Th (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> 'i C y <br /> Building Contractor: ate\ Sewer Installer: E1upkmnS �C1.c ck e r(,iv <br /> AREA BELOW IRIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY x O <br /> THIS PERMIT IS UBJECT TO ALL CONDITIONS LISTED BELOW: <br /> eel c,Ll Se - ,� <br /> 0 5 ,� I cs� <br /> jl,� ' e ti-PP )3-03 <br /> (�,trQ��i f1 eCee� IJn"D ��%� eK �'t'kfio <br /> l 11 (Mtb w' C• l✓s� b Pe P �► <br /> V Fee Rec. _ <br /> a Check#: 5V/0 <br /> m <br /> �j / IJJ, fil <br /> H <br /> Date of staff site visit: ✓)/'` ? 3 Initla of site isit staff: el . <br /> _ 8,:ti. <br /> /h,�APPROVED BY LAND SERVICES OFFICIAL: DATE: J`// /43 = .. <br /> o 1== <br /> C ND <br /> Page 1 of 7 <br /> CO <br /> Burnett County, WI Land Use Application—Rev 5/2023 <br />