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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WIcrro <br /> Applicant Complete All Sections Below This Line 5 w <br /> d <br /> Permit Types and FeesPlease,check appropriate boxes) t7 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 c <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 H <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 1(3 <br /> G� O <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r' <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> I En <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 1 I <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. $ C <br /> b <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t- i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> z <br /> o lb <br /> Property Owner's Name: ��(r\, es- S 1 A Sci. C; .....(--VC,_0-'- o <br /> 0 <br /> o. <br /> Property Owner's Mailing Address:(CI G Iv 6 f L,---Q.. ,St Cane �Fa� - (id ( S i O 7 F. <br /> �1 City, State Zip 4 .k <br /> Property Site Address: ta15 c,e c.i"lU i'`C�t•.-e..I2LSr.-c:� W i�.r u 1 11 41 g'(.i I o - r <br /> 1 [ c ilk <br /> Contact's Telephone Number:1. ( 5 --S Cj 3_c c{,2.g' 1 1 ---- 5 3 -C `-(D,j ' :,. a <br /> l `` d g <br /> Contact's Email: c e_ a_C C Y`5,v,i, 0L to lL' C v Y----- <br /> **If staff has a quest on about this application,you will be ontacted via email. Make sure your email address is N ,.9 <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 7. °� <br /> @BurnettCountyWLgov 11 /l l b <br /> Legal Description of Property: 01 - Q a ` d - z- O i i-t' ()-- C(^ 30 0 Q °G U <br /> Section#: Town#: 9 Cl) N Range#: i 1 W Town of: 5 C—o. „, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* zi <br /> k <br /> N o d <br /> Tax ID#(1-5 digit number;found on tax statement): ( ? 13 I <br /> v. <br /> Proposed Use of Structure/Additiogn:1=c.,vt—G ca ao. ofi CG &y — Y\ i el)Anticipated Start Date: A f,, c- (Home/Cabin;;Commercial Business;Bedroom;Deck;etc) •.0 n <br /> Q O.1.... Cn) <br /> Building Contractor: N� Sewer Installer: Ai + <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> •No- I/LCLJO ;- —►61 y <br /> x Fee Rec:` 0'" <br /> 6 Check#:3LA ? <br /> a <br /> M ' <br /> Date of staff site visit: ViD/2-S Initials of site visit staff c �--) t <br /> m w <br /> APPROVED BY LAND SERVICES OFFICIAl'LU,Q DATE: 2/u 2023 cn n Vit <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF o <W f <br /> 4 2 `ti' Until <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT , o. d <br /> Page l of 5 cn cc <br /> 5'` w <br /> Burnett County, WI Land Use Application —Rev 5/2023 u <br />