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LAND USE PERMIT APPLICATION —Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line c w <br /> Q. <br /> Permit Types and Fees(Please,check appropriate boxes) <br /> C7 <br /> Dwelling/Principal Structure $300 X Addition/Alteration to Dwelling/Principal Structure $200 d <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> ,Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 6.) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 1 <br /> Filling/Grading $150 Boathouse $500 r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 P.. po <br /> *NOTE: After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `$ <br /> *Communication Towers, Camping Permits&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z ,, <br /> Property Owner's Name: Harlan �Tc°f F2CIs o <br /> o <br /> Property Owner's Mailing Address: ?/O/ 951 tons s way/ Wd el" WI 5'1.'73 I n <br /> City State Zip 4 <br /> Property Site Address: Ct.YY e... '7 o N <br /> "� <br /> Contact's Telephone Number:7/S-6-66-0 C$'O n. <br /> d <br /> Contact's Email: II q Iri 4hq a 4i t Ice,e 7 n� .0 wl <br /> **If staff has a question about this'dpplication,you will be contacted via email. Make sure your email address is N ,o <br /> o legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and = °O <br /> @BurnettCountyWl.gov o <br /> 0. <br /> IU 6 ' o> IV sV It ' _Legal Description of Property: %Uf of e144 Eflook )X 0 <br /> Section#: /5 Town#: 3Q N Range#: 1 7 Town of: L)KCO/r'l <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* Y `� .� o <br /> V' <br /> Tax ID#(1-5 digit number;found on tax statement): 33 Y7 Z <br /> H <br /> Proposed Use of Structure/Aiiditi n: Covered Fa O <br /> l] !'": <br /> Anticipated Start Date: gliaDa'13 `(Home/Cabin;Commercial Business;Bedroom;/ Deck;etc.) W <br /> Building Contractor: SC Il /Y Sewer Installer: D yte.... <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Of1'1 e44- ct 1) Se-�A c� - .1 <br /> ,Q,ii II,,A gal- -ID exc�eec( Ca41-Ls k F1 o wA-pp;'ckv.-} or //ritc <br /> OIL;) pe� h `I n / <br /> q��j /�,COv��� 1� Iv G('�'� �i°'� • �T ��t�S�,U4 y Fee Rec�Z� <br /> dale 1 be-h'ee l aO! - PO(94 w o` .i 9e 64 . v Check#:$l i M <br /> m <br /> CA <br /> Date of staff site visit: 7/131g-3 Ini 'a1s site ' it ff: '4- r _ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / 23 y m W Ci)CDC 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o 0 o Q .0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT `` <br /> Irinl <br /> Page lofS ri P.. --- <br /> Burnett County, WI Land Use Application—Rev 3/2023 o C` JJ <br /> cn <br /> 3 <br />