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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line s a w <br /> Permit Types and Fees:(Please,check appropriate boxes) E <br /> C7 ,*, <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 o R <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 V O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 $' <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 <br /> 0 <br /> Filling/Grading $150 Boathouse $500cn } <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? _ <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. Lt <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> p <br /> Property Owner's Name: C. (At'( ;t ,i,w4 4.tiy4f=t Ii' i''''11 " t_^' <br /> A 0 t31 <br /> a. <br /> Property Owner's Mailing Address: 1 /33 /iS (f/ rU ypcc;,H'/ 141% s-4ife'f 7 <br /> City, State Zip cr —X <br /> Property Site Address: I i ? 9 f'L) (ram r,ti( f�J,...^'v' W( I"t ,Y°' o <br /> Contact's Telephone Number: <br /> 6i2 — a(03- 3I C <br /> �� d <br /> Contact's Email: I L3 3 3Cit,4r4, //`V Yl-I ct,` ( , C 0i4-1 ((-{ 31 eW e(7rn4f.fch 0 <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 2 °Q a <br /> @BurnettCountyWl.gov o <br /> Legal Description of Property: S� C 5 1�°4T t '''t <br /> Section#: G 1- Town#: j 0 N Range#: i 11 W Town of: 5(, G r I" C4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* oCD x <br /> N <br /> Tax ID#(1-5 digit number; found on tax statement): 3 3 5-1-2 <br /> d <br /> 3 <br /> Proposed Use of Structure/Addition: Pc) rF;rDt�4. Pt.f9;� e,-, .4'+� l/`I <br /> ... <br /> + c34 <br /> Anticipated Start Date: � (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) J <br /> v/�� 0 "1' <br /> Building Contractor: s�pr, l,t pK:.'v'` Cc,11 5'a I t',`'1 y Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7:, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> — Met- OW- St-l-bac k-S <br /> - Nor hU- ck,Y1 \AC„)o,1+0.Ts on <br /> � oo s Fee Rec: � <br /> CGa, C o ,�lla.t.+ 1004- C ill Ci�/�,c n YV¢.�.d,� I� j1 C "1—rtk �id by o Check#: ! 3rn <br /> r <br /> 1I' zo <br /> Date of staff site visit:1 I Z/�3 Initials of site visit staff Cr <br /> < v = � <br /> APPROVED BY LAND SERVICES OFFICIAL Q DATE: 1 I-7 20ED,o.�o <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF . V 3 In <br /> oc -J <br /> CD 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Page l of 5 <br /> Burnett County, WI Land Use Application—Rev 5/2023 • JJ <br /> 4 <br />