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LAND USE PERMIT APPLICATION — Burnett County, WI a g b <br /> N <br /> Applicant Complete All Sections Below This Line °• <br /> C...)a <br /> Permit Types and Fees:(Please,check appropriate boxes) t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <br /> , <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .,�0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n V" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 o <br /> t <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 `V F. 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. g <br /> *Items not listed above will be treated as accessory structures,such as:perg s,landscaping,etc. <br /> c <br /> Property Owner's Name: �AiD i (/� ` `(�bA► F <br /> P Y Mailing 731 far i L'lJ ✓"l • ti.voir 1LS I 5YZZ , y <br /> Pro ert Owner's Address: -. <br /> (� 9 City Sate Zip <br /> Property Site Address: z�Agjll e • tit D i k- . Ii o <br /> c <br /> Contact's Telephone Number: 1 tc- 311 -- '2-6I`Ih a a. <br /> �} (A <br /> Contact's Email: { A ` L. y` t i+Z- , co� <br /> **If staff has a question out thi 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 a °Q <br /> E• <br /> @BurnettCountyWI.gov i ,� t q^ 1/3 <br /> / ,Q v� _. <br /> Legal Description of Property: `�"� 1 U ' ` 4t /1 l�'3 ` 9 00 <br /> Section#: C-I, Town#: 3tJ N Range#: 1 Li W Town of: ru 4 to CA <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Cy E x <br /> 7 ,_i <br /> Tax ID#(1-5 digit number;found on tax statement): 15�Z' 1 �/ <br /> i_ <r <br /> Proposed Use of Structure/ d ition: ��yJ J V'� <br /> Anticipated Start Date: U ' j? � (Home/Cabin;Commercial Business;Bedroom•Deck;etc.) N <br /> �Building Contractor: i.)--' lir Sewer Installer: A { 4 <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/COND IONS ONLY x <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> L4 cW. S.eAx, S <br /> Dk t al(1C1 If\04 40 fxc -3:4 2- 9,CAIIDOrrIS 9er SII. - t(.Q -l'49. <br /> x Fee Rec:0C3��'' <br /> ?C‘..c(-e-1 y\o1- 4-o tyLe ci. 167I ,r <br /> '1v,Ovl.S SW:CO L. be ctrt fil,r}1yu,+iOn 1 S m Check#: '5412 <br /> r <br /> I_ C cn <br /> z <br /> 71 <br /> Date of staff site visit: lQl7l23 Initials of site v' 't staff: < <br /> IIw / u, m <br /> APPROVED BY LAND SERVICES OFFICIA ATE: 111(�� ZoZ3 Innl <br /> UUU <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° z= Si. 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT m 0 o N <br /> Page l of 5 < w,� N <br /> Burnett County, WI Land Use Application—Rev 5/2023 3 wFA <br /> m <br /> D -J <br /> I <br />