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r <br /> - LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> N <br /> Applicant Complete All Sections Below This Line 5 N w <br /> Permit Types and Fees:(P/ease,check appropriate boxes) C a <br /> } � <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 .4--- K <br /> nA <br /> Commercial/Industrial Structure $300 `Addition/Alteration to Commercial/Industrial Structure $200 v l 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 /> „i A <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C-1_ ot. l' <br /> Filling/Grading $150 Boathouse $500 r <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 a <br /> *NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up tothree times the normal fee. $ <br /> 1 <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. ' <br /> �\1 z <br /> Property Owner's Name: \ SZZCtr)11e- �f � o <br /> ,Bil e G& i h 1 <br /> Property Owner's Mailing Address: g355 ✓ ( ,ls A06 n <br /> r ' ' �. f J City State Zip ° E <br /> Property Site Address: Srl �Jj'ka(' V - 1 U P <br /> O N <br /> Contact's Telephone Number: <br /> CvS► z�i_a 1y 1 a R <br /> boomer IL) � ,- \ d I► <br /> Contact's Email: C� <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is N b <br /> legible and your email provider will accept emails from the following addresses: @BurnettCounty.org and , a 00 <br /> @BumettCountyWl.gov - <br /> Legal Description of Property-TWA\01�� 1111!• e-e cio l.Cn i T i- L-� i• 14, Oa yyc I 4• <br /> Section#: C1).1 Town#:_ ) N Range#: I W Town of: Q-f v <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Q , H H <br /> Tax ID#(1-5 digit number found on tax statement): 09 �� I'" ac b <br /> Proposed Use of Structu /A •i'ti'o � <br /> Antic ated art<- ate: j�[l[�/ (�} 3 O' ; (7iome/Cabin;Commercial Business;Bedroom;Deck,,etc.) —'3 <br /> Building C ntractor: Sewer Installer: .-O <br /> 1 ER r SERVICES STAFF COMMENTS/CONDITIONS ONLY z <br /> �V TI3'LL�N <br /> AREA BELO P:1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> d (171ee1- ct 11 SeTh&cks CSfet.Gcs ✓io f- reS ems- & f;i1e c :45pcJ ) <br /> - � 4� hob, -h / <br /> 411 roper th cfji- be T- (� a/1 U d;1-- S p-F T'w. Jt�nS Ca4,10 co <br /> Q P i/,, J f p, �N.l CUiI� Sul /.. Fee Rec: ?J� <br /> V�l ICSS CP'tU �a'� 5 `-�1 o Check#: /41,2 <br /> 014t74- 1°"cl <br /> :� :, ,tee on J o,'i f 'M itk ) ' <br /> r„ <br /> „, , <br /> 1 ate of staff site visit: �'���3 (/I 1�v itial f sit vis' staff: < �U� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: g j16/23 y Q IVii <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF z 3 r 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT . 0 N <br /> c4 <br /> Pagelof5 3 w <br /> Burnett County, WI Land Use Application-Rev 3/2023 v <br /> z Fin <br /> aLk........ �) <br /> 3 <br /> -o <br />