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LAND USE PERMIT APPLICATION - Burnett County, WI C <br /> r b <br /> Applicant Complete All Sections Below This Line a cw <br /> Permit Types and Fees:(Please,check appropriate boxes) C a W <br /> C <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0- cD <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ,A <br /> Accessory Structure(Garage,Shed,etc.) $150. ,Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 g v/ <br /> Deck tail/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °e° 0 A <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 C <br /> Filling/Grading $150 Boathouse $500 p <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 0--- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. C <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o Li <br /> Property Owner's Name:D,1 i t, aI d /4 g,ei lit.) i i Gf L/li=- 1 LIi.s f ;Li <br /> a <br /> /} y� <br /> 29 <br /> Property Owner's Mailing Address: ?�a ZA 1CIC I c'- ,Sic��.f'I i P kit,it,grss9 ;v, n <br /> City State Zip k) <br /> Property Site Address: ,S'4ntG \ o y <br /> Contact's Telephone Number: 2/5- ,2.742— /�721/4166. CD <br /> 14 <br /> Contact's Email: did /i ci►t/ li P- e? l" J7) 4/2 , C .'►-t <br /> ab**If staff has a question o this application ou 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 °o °Q <br /> @BurnettCountyWl.gov (Q-,7©q/) v=o -..k <br /> r I di it' (. <br /> Legal Description of Property: .4 n 19(Aed2 Q. 6'j/I e eM 41J 3 3A41?> 3. ►. <br /> Section#: 5 Town#: 32/i' N Range#:i ./b W Town of: 44 i 2//`7 :, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* f ' <br /> Tax ID#(1-5 digit number;found on tax statement): /002 i <br /> Proposed Use of Structure/A dition: ,SY/j//Z S /O d <br /> �`A/�-C��- l n�-e�/l�Ce- p 1/ S' Q i'Ls <br /> � <br /> `� W <br /> Anticipated Start Date: 0 a 0,2 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) \ p <br /> N <br /> Building Contractor: DA/t? / 0 4> Sewer Installer: V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ' n <br /> s Fee Rec: lc ' <br /> c Check#: /7.%2 <br /> m <br /> z <br /> v <br /> Date of staff site visit: 6' U/Z49Z 3 In' •' Is of i e visitaff: rn <br /> Fri ET <br /> l J <br /> APPROVED BY LAND SERVICES OFFICIAL: /"---`" DATE: /e..5/20?-gR = <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 2 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT { o <br /> Page l of 5 al< 3� `"' <br /> rt, RI <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> cn <br /> 3 <br /> -o <br />