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LAND USE PERMIT APPLICATION — Burnett County, WI CID <br /> i <br /> Applicant Complete All Sections Below This Line 0 c w <br /> C <br /> -mit Types and Fees:(Please,check appropriate boxes) ° <br /> C- Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CD <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 /> "1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 • <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 t ri <br /> Filling/Grading $150 Boathouse $500 <br /> AD <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 tothree times the normal fee. ` 1% <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. - 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> • <br /> Property Owner's Name: �- ,,� a,c>moo- ya o(is‘ P <br /> o <br /> a <br /> Property Owner's Mailing Address: . A" C w n ' x • <br /> RA '� Q ) City State Zip ° `�' <br /> Property Site Address: 3 © Rd �iL ,l..) S 7( -. <br /> nc N d <br /> p <br /> Contact's Telephone Number: t Azi-o-C PI es Z'-5�—SZ U —,)-�3 5-4 a. <br /> d <br /> Contact's Email: cam,,-k e I,- 176SZ Pj-kk ex, , cL G :% 0 <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is L <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and b0 <br /> @BurnettCountyWl.gov r L 2 VT <br /> d <br /> iii <br /> Legal Description of Property: Di: SE L'I n 0. C L 5 9 i.0 <br /> J /Section#: 2-,3 Town#: 3 0 N Range#: S W To of: /-ct-rj//-- <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number; found on tax statement): 6 <br /> -3 % <br /> Proposed Use of Structure/ ddit'on: D u)t 1,`, <br /> Anticipated Start Date: 7 -- a-.3 ��.�,`abin;Commercial Business;Bedroom;Deck;etc.) , . <br /> Building Contractor: C N Sewer Installer: � c-� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z 11 <br /> i <br /> THIS PERMIT IS SUB) CT TO ALL CONDITIONS LISTED BELOW: <br /> i i v1-ems-- �� V 5 \ <br /> gel(, nc))- -a e %, 'I bee odxs ei' S Gti-2--l3 <br /> C MA-- ,17, eA.c.ex-- Li 111 = Fee Rec: --t <br /> o Check#:j' , 7 <br /> if D OnQ slydC izh- <br /> z <br /> tt <br /> Date of staff site visit:'7 5 3 Initi s of s' sit staff: (' < r �J`J <br /> m = H/ / m <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7/? l ?3 ._ c- <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Z , - <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N <br /> Page l of 5 m <br /> w <br /> Burnett County, WI Land Use Application—Rev 3/2023 0 �L <br /> -3 <br /> a <br /> 3 <br /> -o <br />