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LAND USE PERMIT APPLICATION—Burnett County,WI <br /> Applicant Complete All Sections Below This Line c ccaa <br /> Permit Types and Feeselease,check appropriate boxes) n <br /> , <br /> Dwelling/Principal Structure $300 r Addition/Alteration to Dwelling/Principal Structure $200 _ c <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � D4 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 -t \ <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> iBunkDeck/Stairs/Patio/Retaining Wall/Sidewalk <br /> house $250 , G <br /> Driveways/&Campground Structures $125 Wl State Statute 59.692(1v)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 r. <br /> f <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. `< <br /> -c <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. K <br /> _ z <br /> Property Owner's Name: tt' U(1G� K(1'�lc! i 1 P r o <br /> c. <br /> Property Owner's Mailing Address: 3 V'I I CO o I'l ftj Rd I7 Wpb4 r-' Wit 5`I 13 w <br /> City State Zip cip <br /> III <br /> Property Site Address: . C_ J t I CO O il+j RA- A'. o in <br /> Contact's Telephone Number: CP cJ I`6 Q O - c/30 \ n <br /> o <br /> Contact's Email: k-sch,r,Q ede r e Co M CQ -1l • Ad-- =' <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.a <br /> o legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 00 <br /> @BurnettCountyWl.gov w <br /> /; Gt <br /> r7 <br /> Legal Description of Property: Z.-.,VI( 4CU 0-1-c1 R4 —�^a F �.. <br /> Section#: p�.3 Town#: 1(© N Range#: i 5 W Town of: Zack 5 1'1 . <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> �1 a <br /> C7 <br /> Tax ID#(1-5 digit number;found on tax statement): rJ" CJ <br /> p Dec k ---',Dc.c k— Alu'/) 4 't f—Pro used Use of Structure/Addition: u 1 �t G15 <br /> Anticipated Start Date: ? (Home/Cabin;Commercial Bus ess;Bedroom;Deck:etc.)4 pC.46LA4 l I:- O H V <br /> Building Contractor: Sewer Installer:_ Pr N <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: v\' <br /> ,0 Afpe_cfrs --/hS rl'p/ref is s/►qAf/y abd tA.,z, z-6 <br /> o ty IAD w) m //- L II / LL <br /> 4 /Y!/G7`U S a 77'0 S Q/2.C.5 LTG /IA e- n <br /> o/H S / / / s Fee Rec: I g, <br /> ,rzdt�U V'e. um le, /N^ '�'IA'd U S a Ys t G /S �Cidge- 4. Check#: �1 J 9 <br /> g ���a � ho aG sduT of Tl � /a174� /1i1 D <br /> z <br /> a <br /> Date of staff site visit: 4 1214 4 23 mitt is o ite vis' : <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 0/20 2-3 cn <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF � W z m .:: rya i u'n�,I i <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 N <br /> Page l of 5 < B IN) <br /> Era <br /> Burnett County, WI Land Use Application—Rev 5/2023 0 <br /> .33 <br /> L�JJ <br />