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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line g w <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> C 7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 F <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 ...I p <br /> � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 0 g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 n p, Fr <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permit: (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. 77 r <br /> r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> i's. <br /> Property Owner's Name: A i C i/6 R 0 i- klCA/iJ. 0/0/y o H <br /> a. <br /> Property Owner's Mailing Address: 'a, y 3L Pi PrA/ R 4 w4 i3STLR w/ ,5'%8l3 F. r, C d <br /> City State Zip '' v <br /> Property Site Address: SAC//_ /9 5 II Ce VI < v. i <br /> CD <br /> CD <br /> Contact's Telephone Number: 4 p 9 8 /aZ 66 a_____ <br /> Contact's Email: c/ /04 / 5 n <br /> **If staff has a question about this 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 °0 <br /> @BurnettCountyWl.gov S u A 1iisr y 11t},0 4- 3.5/ / ✓0L.v,tii / P II= 2/ `/ a v <br /> o (_ <br /> Legal Descri do of Property: R: P. iV �' 0'7 -0 2_8 —'off,— 90 -i -1- •3 V S t�S-OCS-0//00O ^. --t <br /> Section#:_ Town#: L/0 N Range#: I q W Town of: 5 Co T-T <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H H <br /> Tax ID#(1-5 digit number;found on tax statement): / 8 70 o <br /> Proposed Use of Structure/Addition: S'%0Ri'I G-E O/ TR4/4E/Q l /c'oQ i itif/=1z Lets is rc, <br /> Anticipated Start Date: 7 ..i0 - 3.-3 (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) Q • <br /> Building Contractor:f/9 M/S//) Sewer Installer: /k//9 Q <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - 1\ktik cp S-Z-4"Ioua-S <br /> - N1 r, e 0 <br /> T_ —?Lfi \,\0_ 0('Cf,.l ' Fee Rec: � <br /> d Check#: 6/19 <br /> m <br /> r <br /> D <br /> z <br /> a <br /> Date of staff site visit: 7(5/�2-- 416/23 Initials of site visits ff x <br /> Pg j <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: I DIZaz3 a. <br /> v a ultu <br /> ��i <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 1 a <br /> Page 1of5 ri 1 g < <br /> Burnett County, WI Land Use Application —Rev 5/2023 v ------�•••.�_' <br />