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LAND USE PERMIT APPLICATION - Burnett County, WI c <br /> y. , <br /> Applicant Complete All Sections Below This Line 0 c w <br /> a <br /> Permit Types and Fees(Please,check appropriate boxes) C7 r..... <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 0 <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 /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 l� C <br /> '` Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 ``' <br /> " up <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 permits(permit acquired after construction has begun)may cost up tothree times the normal fee. `5 <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. R ' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. = <br /> Property Owner's Name: fr1/C//A LL )i .,J O, /(/f4 o o <br /> �� f ( / o • <br /> 0- <br /> Property Owner's Mailing Address: IV/ 2c/(4 [/ ` L/(9,"91� 6t� ✓.i///' /`,j : n <br /> C �j L /� City State Zips E <br /> Property Site Address: //9 ) L tW fj L A fd Defitel/f WY-'5 ,' o o N <br /> Contact's Telephone Number: 6-Q- 4 71 -/f3‘ '1`j 2. <br /> Contact's Email: NA /0&41/5C) d L" (�/2-1'i/Y4 eCD <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following addresses: @BumettCounty.org and 5 °Q <br /> @BurnettCountyWl.gov j ` / L of <br /> Legal Description of Property:/4'"or'sct'6/Awl/ocs/ed & e /d~,/ ,/ , 5. <br /> Section#: 7 Town#: 4/0 N Range#: /Y W Town of: Sc c ' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d 0 ' <br /> Tax ID#(1-5 digit number; found on tax statement):` )�7,�,7/° rr /� 1 ` J� V DQ ' 5 <br /> Proposed Use of Structur /Addition: //'19 t,; a e /%'/iJ Ctt, 46ce--ss f4 L4 Re H n <br /> Anticipated Start Date: 'f/- Z3 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: .5e/T Sewer Installer: 41/. <br /> z Cj <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 0 Me- a(( 5 e-6„,,1k Gdd so�l� - � <br /> 0 ?.e,n v.. VedA I GTed to f f(c P Ion/ -} 44- V t 5 J / <br /> 44 7 ' " CKCe-eSS "I k 5TT h al low-cc" <br /> �� �� x Fee Rec: (�'J <br /> (id;C� o Check#: (,2 2by <br /> m <br /> z <br /> / v <br /> Date of staff site visit: 7!�5/�� Ini 'al of site v' it staff: < ' — <br /> ' m a Inn <br /> APPROVED BY LAND SERVICES OFFICIAL: -� DATE:7l0(o 6.- c, ll u L <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o B I- <br /> z co "' N �U <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o c' <br /> Page l of 5 c- <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> rn (� )_)' <br /> i <br />