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LAND USE PERMIT APPLICATION - Burnett County, WI a- 6 <br /> b <br /> y <br /> Applicant Complete All Sections Below This Line o w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> 1 ,-' -,i- 0 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 °, S <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 9. 7 <br /> Filling/Grading $150 Boathouse $500 u4 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 o �- <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. ` <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> r- <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g I p <br /> z - <br /> p <br /> Property Owner's Name: John 4- Lu. 0.' 6-ec 1&c i.., <br /> 1 I o <br /> Property Owner's Mailing Address: 19 0 �pr STCn/ LAM) 'S �D�k a l�5 wT S`�(�� n -Z3 <br /> p p City /State Zip E ,D <br /> Property Site Address: 1 Z 1 5 Sei4%) ' On Q 1.oca j C./1otlf10/ , w i 0 Yet y o N S_ <br /> CoISS -- Sg3 - o 2.S� , 71s - 553 — O42- - <br /> Contact's Telephone Number: -aContact's Email: Q/`I a_c L'' ✓ti V a' ,/' ©`.�-'t OO ' C©A.-.,**If staff has a quests0 n about this application,you will b contacted via email. Make sure your email address is N 'o <br /> o legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °Q <br /> @BurnettCountyWI.gov oZ <br /> t. <br /> Legal Description of Property: ,0 7 - 6 Z$ - Z — `t D - P! I2---�2 01 OW - 611000 i. <br /> Section#:.S 12, Town#:T4o!�l N Range#: R 14� J/ W Town of: C O It r„ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> (A) N a <br /> Tax ID#(1-5 digit number;found on tax statement): 19 3 L <br /> j`� I f H <br /> Proposed Use of Structure/Addition: DEGICheti( GcAr-a� 32 X 36 <br /> Anticipated Start Date: .July (I "n` t ZOZ j (Home/Cabin;Commercial Business;Bedroom;Deck;etc) G.i <br /> Building Contractor: J o 4 C_e.,,, C Sewer Installer: A /t <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 /> •MR-t,4- ail StA-ioackS <br /> -NO- -C-Or \nu m.L-h V\okb-k-6- an <br /> -1166;A-ion40 -i-(iu d ,(Lt n Y1eeA plrtr,Q lif-e f2rm i+ boy l 5 I23 a.r x Fee Rec:/50� <br /> ►� a Qr►\N on -i-V2� prop-h -A. w�l� nuA a Nam` f�.m►il�j S �i-k�.r� permit v i(51.t,3 4 Check#: �t,Q 6 <br /> rn <br /> •An,i QU e SSDC`( S+ru.t u.-es (Qv For4-) Cas , conitun er rttrt. rerntAre.d of}ei cons-r td <br /> I needs A. Lid Use <br /> Date of staff site visit: (.0'2(0/Z3 Initials of site visit staff:ZT Per 1'i rf �CJJ <br /> � � Q /ctik.,' cn cn =APPROVED BY LAND SERVICES OFFICIA DATE: a <br /> irW c <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o N Erifil <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT .o 2 o <br /> Page 1 of 5 3 c <br /> Burnett County, WI Land Use Application—Rev 5/2023 - co <br /> b <br /> Q <br />