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LAND USE PERMIT APPLICATION — Burnett County, WI a 1-1 <br /> Applicant Complete All Sections Below This Line E• CD w <br /> Permit Types and Fees:(Please,check appropriate boxes) a U11 <br /> C7 w t <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 i9 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � o <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 \ g <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 II, <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 0 or <br /> Filling/Grading $150 Boathouse $500 _ <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 7 <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. b L' <br /> *Communication Towers,Camping Permits&Signs require a different application form;see corresponding application,and fees. t �` <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> f / L ,� is <br /> Property Owner's Name: de J CJ- 7504 43f.o if /Ks 4( ,-, /c ivey i-eo e f!-�-Pa 1�4(4 1- W �,, <br /> Property Owner's Mailing Address: /5'�7 t13 r+ .s/ //act/7.YA Ut CVO'b peri� r�r/`S l e J <br /> _ r <br /> �y ? ✓�'�� ,.� City State Zi <br /> Property Site Address: c2 703 J et, , / ��S��f s- v�q_i < �� <br /> Contact's Telephone Number: 1/,1 — 2 Z 0 — .51 /U a <br /> 0 <br /> Contact's Email c,y , T,-,,„c„ g s- 4-/y 4 ,/ , C D:."\ <br /> **If staff has a question about this application,you will a contacted via email. Make sure your email address is N g- t <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and S °Q <br /> @BurnettCountyWl.gov /� o'o -W <br /> g P Property: S V V - T Qf T ` Ff, '�� <br /> Legal Description of Pro e / � S�/1�1 0 , <br /> Section#: t-)5— Town#: /4.Q N Range#: /b W Town of: O�X/t� c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* N <br /> IN, i' rti <br /> Tax ID#(1-5 digit number;found on tax statement): /36 J 6 <br /> Proposed Use of Structure/Addition: ac ar j -e P w <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ..l\ <br /> Building Contractor: -S-(/" Sewer Installer: ,4 f/ ,Z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> — l-RA c st-Nock -3 <br /> — t -,r V1wrn.u.n \tv,,,V,*(-I-rki-ibrk <br /> x Fee Rec: O <br /> o4. Check#: <br /> m <br /> z <br /> QQ cA <br /> v <br /> Date of staff site visit: O/k(/2013 Initials of site visit staff T ), <br /> -�\ a L v <br /> APPROVED BY LAND SERVICES OFFICIA ATE: o /J/2bZ� CA CA Q. n <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z CD 3 ```- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o= . <br /> Page 1 of5 -� <br /> g < f <br /> Burnett County, WI Land Use Application—Rev 3/2023 v <br /> L� _ J <br />