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LAND USE PERMIT APPLICATION- Burnett County,WI a <br /> Applicant Complete All Sections Below This Line c w <br /> Permit Types and Fees:(Please,check appropriate boxes) p °- <br /> C7 CA <br /> X 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 /> Y <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 o b <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r°r. yb <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. r <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> z <br /> 4-- <br /> Property Owner's Name: /3c.fb c.-Z 34-cu,_ 6,i1a,-- -' <br /> o <br /> Property Owner's Mailing Address: 5/y I ►'LSt /1/LAJ /14,, b y h,<a.. M/'I'I 3//2-f; ; <br /> nn "� City State Zip E �O <br /> Property Site Address: -`l 410 Fos,.i c ( r i vt 'vV^b S U 5'`1593 c <br /> • • <br /> Contact's Telephone Number: / -6/Z -c O -G C"93 a <br /> d <br /> Contact's Email: bb O 1 I v` '�n `�1 oe .Co r <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N = 9 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °O <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: L v T Z C_5 Al U J- P G L/ 3. <br /> Section#: 0 1/ Town#: 58 N Range#: !9 W Town of: Lci Pp/le 1 ie._ 1Z , v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(1-5 digit number;found on tax statement): 9 ZS-G0 a <br /> Proposed Use of Structure/Addition: /-)o;-,c- l CAA b,,A <br /> Anticipated Start Date: M aY l (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M g :IN) <br /> Building Contractor: j3,�.2 AZcgc -, �S G Z")�L Sewer Installer: QK s 4 S 50^2-a.Z G-=K vy 6• <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 meet au 5C4JOcit, U1 <br /> 0 f)weill 14v-f- 49 e ceed 3 b 5 et, Nff-?3-04 <br /> •c 4T/-ok wd4:4 lie. 75 0 Se+b,dx c col a utIVe ;}u A v'?)C s,- <br /> L 5 Jr Q 2�(v)$T MK t 5 cc 't €c Zer( Qr fl c . r'f%5� x_ Fee Rec:�ct v / <br /> (7 � � � Check#: �?�,le are,. ec.s-4- cxl1hiw rCc,i) •45!-b /eyed14Yrce1 ,44,4 — S helot , rA i/3 ( /4 a5 SLAT e 1-e*,( a <br /> v 1 z <br /> lam, (. <br /> ri <br /> o .____,,,,..j <br /> Date of staff site visit: �"'��� itials f sr it it staff: x <br /> n 1,7, <br /> Till <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:51 c /' 3 <br /> ° 3 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o m 0 <br /> z ..« <br /> Cifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT w c N <br /> Pagelof5 < 3 w <br /> CD friiii <br /> Burnett County,WI Land Use Application—Rev 3/2023 d <br /> 6 <br />