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LAND USE PERMIT APPLICATION - Burnett County, WI a i <br /> Applicant Complete All Sections Below This Line 0' c w <br /> PP P CD , <br /> Permit Types and Fees(P/ease,check appropriate boxes) n. <br /> a•Dwelling/Principal Structure $300 XAddition/Alteration to Dwelling/Principal Structure $200 . <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 1 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° � 1 <br /> ,Driveways/&Campground Structures � <br /> pg $125 WI State Statute 59.692(1v)Structures $350 �' <br /> Filling/Grading $150 Boathouse $500 Fi w <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 (\_ E. <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. 'V <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> o ' " <br /> Property Owner's Name: -7[_! e �-o <br /> Property Owner's Mailing Address: /Z3 / 57Z.5T"S. 0 <br /> -51e /---4/if �J , 'w n i1 <br /> [' City State Zip <br /> .. D ° <br /> Property Site Address: � /mil` Z� 15- j .'� _iYil < <br /> ' / `� ° o <br /> Contact's Telephone Number: ��7- ��Z � C ado J Gxd' <br /> Contact's Email: /,-e ®.; Is- <br /> CI <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and I. <br /> @BurnettCountyWl.gov <br /> l <br /> Legal Description of Property:Lll� ( <br /> c 5� V?6 P as 1 c6,✓ �?J •. [..4 <br /> ,.. <br /> Section#: 1 I Town#: 17(7 N Range#: / 1 W Town of: 5Co+1 c0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o ii <br /> Tax ID#(1-5 digit number;found on tax statement): ..�4?.5� � <br /> Proposed Use of Structure/Addition: /� �,el c"l-c-�f {���12_ OJ/ j H W <br /> //L -<<'L._ ". <br /> Anticipated Start Date: O /'-,,ZO.3 (Home/Cabin;Commercial Bu ness;Bedroom;Deck;etc.) cZ S tZZo <br /> �/' <br /> Building Contractor: , s R(;r` Sewer Installer: ,�_ <br /> AREA BELOW THIS LINOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY CD k V 'z <br /> THIS ERMIT IS SUBJ 'CT TO ALL CONDITIONS LISTED BELOW: _ <br /> j meet- a(i 56+6,�&. �-c- <br /> 1,. �rce 2 bans r Ste- iso77 <br /> ® p,vel nv f -ro e P` L 1 ri <br /> �\5,-t l) y e r✓,U,^s -(e dux beta/ n'��j7 Ili•fi y,-Pv 4 = Fee Rec: v2 D4 <br /> 17, <br /> 7 e t,N V $ D�'\ riCV1 v'`S Vro� e4 �eIflV. S. m Check#:3GS?�?C�5k+ s -�b.t bAS ? z <br /> v <br /> Date of staff site visit: / 1 a5/�3 In'tials of site•v' 't staff: <,_,- fa ,...... tug <br /> rr, (.,•, <br /> APPROVED BY LAND SERVICES OFFICIAL: ILJ+�U' DATE: !/v`C/ C, 51 i r <br /> -a t <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF i c=, HI <br /> z t <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTi m ccs <br /> , <br /> Page l of 5 < Tiff I <br /> Burnett County, WI Land Use Application-Rev 3/2023 o L j <br /> a <br /> s: <br /> -o <br />