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LAND USE PERMIT APPLICATION —Burnett County, WI 0 0. <br /> ci N N <br /> Applicant Complete All Sections Below This Line 0 CD I <br /> w <br /> Permit Types and Fees:(Please,check appropriate boxes) Cl.d 1 <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 cc <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Ci C <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 ' <br /> Filling/Grading $150 Boathouse $500 v) . <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 . <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. •$ <br /> *Communication 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. 0 z <br /> 0 <br /> Property Owner's Name: ,`/*'r/E/'AC=L Li Q4L tc -a- 41A /4 L/S4L& c_ o r� <br /> 0 <br /> a. <br /> Property Owner's Mailing Address: f'9/A/c944v/ to.4/ S Ti L1.14 Ara 41 tI 72 8 pZ n <br /> "� / City / Sr} Zi <br /> Property Site Address: 2 3?CJ .R4/4 R Idf-e A: ( gx i`Y/Sc ( f1`-Yo o N ► <br /> GSi/v14-kSil_A-N'D <br /> Contact's Telephone Number: 95) .3! 72 2 ia.n <br /> ' -bAkc A b CY A'L , D yrr <br /> Contact's Email: ` <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N ,.o <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and 0 °0 <br /> 5' <br /> @BurnettCountyWl.gov °O �. <br /> Legal Description of Property: tor S ( 5 1 Sv i V D L L 3 p 161, C & 7 032> . <br /> Section#: 2-7 Town#: 3 9 N Range#: r 9 W Town of: (A/c 77///4/25//LA4i 't v) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 0, <br /> J <br /> Tax ID#(1-5 digit number;found on tax statement): 3 5-6 3 9 <br /> i <br /> C7 <br /> y <br /> Proposed Use of Structure/ ddition: 51Ne d <br /> IzAnticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: <br /> z <br /> M <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Oleei-- ctll se,f-j4 <br /> co+ ;( 11,4/4.1.4 <br /> habliT,Aic,./) s <br /> ceti:, ef_ <br /> cxiler1,1,,cd5 /4. Jxcir /h <br /> are +41A 30 ID-1,‘,1 40'5 i et <br /> A y Fee Rec: <br /> �• �i,6 CO/1 •� lal b( c4 �b tt/45�10 I o Check#: <br /> tz <br /> r <br /> V _ <br /> 1r cA <br /> v � J <br /> Date of staff site visit: Silo 1�3 i ial of site v' it staff:i'f� tii <br /> < 11 u u <br /> n a . <br /> APPROVED BY LAND SERVICES OFFICIAL: " DATE: ?l//1 3co .' �a, 0 <br /> a m UPON APPROVAL: APPLICANT MUST POST COPY OF zoo em-- - IT <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT { °` C< <br /> 3 ca <br /> VT <br /> Page 1of5 rri ffff <br /> Burnett County, WI Land Use Application-Rev 3/2023 y J <br /> -3 <br /> a <br />