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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ° c w <br /> , <br /> Permit Types and Fees:(Please,check appropriate boxes) a VV <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 co <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 \ N <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < --1-. <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 K t/iFilling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 I <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. I. lb <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> Property Owner's Name: tH ( k "ifIll (4,1111 Y V v r a_I - On n1 'Mil'i/, `.zpn <br /> Property Owner's Mailing Address: PO 60X 6% /I/ Wee§ , vvl g f- t n <br /> �^ � (4kb B,� may State Zip `' <br /> Property Site Address: 9-0 � (,Z - tJ <br /> Ci o N N <br /> Contact's Telephone Number: 7/5 77 d-5S7o c <br /> Contact's Email: a cv/70 -7;77" 1 CD <br /> **If staff has a question about this application,you will be contacted via email. Mak ure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and °o °Q <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: 1,94. I (-5- (I V 1'1 Fig, (fyW/vEi) 6. <br /> W <br /> � <br /> Section#: l Town#: //O N Range#: /5 W Town of: ( _i(-/) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* NV <br /> Tax ID#(1-5 digit number;found on tax statement): 9-0" d <br /> Proposed Use of Structure/Addition: 'pill cam'/ -'/� oQ <br /> Anticipated Start Date: (a del. 3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) --C CN <br /> Building Contractor: /� _ Sewer Installer: <br /> n/ G • `r <br /> � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> A,6en444 as mow, Z1=/,-2/-aV�47/ cil <br /> of ypS �� /� GO 20Z3 (2yi Fee Rec: (�_,_ <br /> qS = Check#: <br /> �� O 14 /14Q/ ' i7 /1)0 ©./a ( 42k :271_1 <br /> a I D z <br /> Date of staff site visit: 15 12.02.3 it'als of site v' 't staff:4 r < <br /> ffil <br /> y c. c 0 <br /> � <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: l 7 .GCJ <br /> Z <br /> c <br /> --33 -' 3 Z <br /> c) co <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z o o . Ind" <br /> SIGNED P IT APPLICATION IN LAIN SIGHT; 2:i w <br /> I � � <br /> �� �J /c0t.lLte4AQ, S/�9 �, ��1M0 Page 1 of 5 <br /> 40 3 Bu;t�nett County, WI Land Use Application—Rev 3/2023 C L. JJ <br /> b 1oyL 2oZ o <br /> y <br />