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LAND USE PERMIT APPLICATION—Burnett County, WI g 2 ro <br /> , <br /> Applicant Complete All Sections Below This Line 5• w <br /> Permit Types and Fees:'Please,check appropriate boxes) e <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 '� G <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 p <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n C_. <br /> "Dec /Stairs atio/Retaining Wall/Sidewalk Bunkhouse $250 ° R <br /> Driveways &Campground Structures $125 WI State Statute 59.692(1v)Structures $350 c <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 to three times the normal fee. `r in <br /> — <br /> *NOTE: 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. t ` <br /> _ o <br /> Property Owner's Name: �e j c 5ii tsA --Jr (ENinlf /\is 6.-ei< <br /> 4e <br /> Property Owner's Mailing Address: g-]' D5" VA`�S 517; �E 57Ci /�/\) 5-S ... <br /> ? n �� <br /> 1 City State Zip E <br /> Property Site Address: 42. 1014 3 6,4.:47.x ,1)• ) /MAO i444.`/) I/J1'• y c7Li3, D Z 1 y <br /> Contact's Telephone Number: Go 5/ 3 L(/ - `74 S G C7 _, <br /> Contact's Email: (TC6 ki t')l4Z6110.< 6 W+ l.- . C6 AA <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 S. <br /> @BurnettCountyWl.gov o <br /> Legal Description of Property:Z.aT.2 CSM#l39/ V 7 p 0 Sz,G. 1 Le c,r, .)w/gismi T d <br /> Section#:t1 Town#: `o N Range#: f•-f ir� W Town of: SGo r-r =„ <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): t 7 —7 9 9 <br /> Proposed Use of Structure/Addition: 5-reP3 %v z_Afic E. 1-Q <br /> �1 <br /> Anticipated Start Date:4,4/.4 eitkL Y (t MP/EroyHome/Cabin;Commercial Business;Bedroom;Deck:etc.) .j <br /> Building Contractor: Sewer Installer: q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 <br /> ree-1- <br /> j ,-. ... <br /> d 1';(e ,-' area. 1" .7no' eb IPeitn /o/ V/ot/iq' _ <br /> t 4,(I; -}D Q6 I?-J i ) 3 L� <br /> `/ g Fee Rec: a J /— <br /> i� t± � eA2� YO,S ,-. 5 Check#: y <br /> a <br /> Date of staff site visit: 7/I 9 ?3 I ' i Is site visit atf:f�/✓ < <br /> a - 7/31 �a " .— <br /> APPROVED BY LAND SERVICES OFFICIAL: �`�' Lf DATE: H <br /> o. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o CD c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD c N <br /> Page l of 5ID� w <br /> Burnett County,WI Land Use Application—Rev 5/2023 0 C N <br />