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LAND USE PERMIT APPLICATION - Burnett County, WIcr <br /> Applicant Complete All Sections Below This Line 0' cn w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) CD 0t <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 °� <br /> Commercial/Industrial Structure $300, Addition/Alteration to Commercial/Industrial Structure $200 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 Z g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < J l O <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 !N <br /> Q.)Filling/Grading $150 Boathouse $500 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 c <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. <br /> ro <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. F. , <br /> z <br /> Property Owner's Name: �G' idof Q f l�'Ot�cl Xf t/'•tot_ F o e <br /> � iI> <br /> Property Owner's Mailing Address: ` (.'.3 /0 tf• l /p Ai A 0' an <br /> �[ City State Zip ° `" <br /> Property Site Address: ,j 610 tI''1 Q Dk CL�/Il2J2� Al• < r <br /> 4 o ti ` <br /> Contact's Telephone Number: p _ a <br /> o d <br /> p0 <br /> po <br /> Contact's Email: V <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is :c ro <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and tl° <br /> @BurnettCountyWl.gov <br /> Legal Description of Property: PC../5 /`1 r'r`�' 5/49"5 y sl ^ 510 5. <br /> Section#: /5- Town#: 3g N Range#: /O W Town of: tJCypC1/ /q/jfp4/` o) <br /> *Attach additional page if needed for lengthy description OR attach✓a copy of the deedee OR attachtax system property7 page.* f <br /> Tax ID#(1-5 digit number;found on tax statement): z gea 7, 2 0 6 / /, 28667 . \ d <br /> cv <br /> Proposed Use of Structure/Addition: Gt,t/V`-a/'� f q C,t?O,v�.�ev7{ Al /i/pAct ,Dr .. ,. � % <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) W O OQ <br /> P-,>•O <br /> Building Contractor: Sewer Installer: <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 /> Q Ti 6 re fic,c to/7 7IAe. Se wle- size c.u`1,42.4 \`-Z <br /> vt� a � e- Some. c-im u477 o <br /> Gcii . <br /> CMrrtvl7 (y D / treya m4 r/Gu t x.'e,e , FeeRec��1 <br /> c Check#: <br /> rn AN, -Fe e_.l— <br /> / � o T wn I�rnjed <br /> Date of staff site visit: $/ 0/ 0 Z 3 Initials o ite visit staff: <br /> - ` r--- <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: b /7 2Oc j � <br /> ca. ` it u tJ <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF .?co <br /> C 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT p o w it Gfl <br /> • c rV O <br /> Page l of 5 `I: N <br /> .. w <br /> Burnett County, WI Land Use Application-Rev 3/2023 �U <br /> a <br />