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LAND USE PERMIT APPLICATION —Burnett County, WI c <br /> a g <br /> Applicant Complete All Sections Below This Line o' c w <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) (ti <br /> _ b lrL' <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1.9 <br /> "©X Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ' <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o lop <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r • <br /> Filling/Grading $150 Boathouse $500 <br /> cn II <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 ? Ilt <br /> v <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. <br /> \ <br /> • <br /> 1\ 0 <br /> Property Owner's Name: A_ C1.i1d. ` .t O\\e �..y._- Cr <br /> c o <br /> Property Owner's Mailing Address: P. C) a 0 X. k JO'I`i1�c-se__A t �. 51+0 LT 1 <br /> Ill <br /> _ -� City State Zip cp 0 <br /> Property Site Address: 52G 1 CO\'1�51�\*`'1 l \c(so\ �0.�\3V,-f j \ft �L{ g 3C < <br /> Contact's Telephone Number: `. `3—- 1 1 1 .-5 0 C{ E. -� a <br /> , <br /> Contact's Email: 'R a.-W1iPC3t,13�\\ e ,—�Qn - C() , <br /> **If staff has a questio about this application,you wilrlide contacted via email. Make sure your email address is N -o <br /> legible and your email provider will accept emails fro the following addresses: (rBurnettCounty.org and a °' <br /> @BurnettCountyWf.gov 5eet}1_ ( \ ` � <br /> Legal Description of Property,: C�es'1 d \�-�\ G-1 ?c O�gv�C- \ V C e-S+ <br /> Section#: 0 1 Town#: I N Range#: 15 W Town of: De. ", 2.v-cy w <br /> rwrN p-q W1.S-S , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system prope ,page. E o , <br /> F <br /> ° p <br /> Tax ID#(1-5 digit number;found on tax statement): Jr'33 \ r <br /> Proposed Use of Structure/Addition:V \---‘(`j�alike_l C11 Y l-'YJU Ci t� \`fl pO\� � 4 <br /> Q� <br /> Anticipated Start Date:^ c�(>� .1 i'Z02_�j (Home/Cahin;Commercial Business;Be nm;Deck;etc.)Building Contractor: #��(�—6 C a�S�eea Cod-0c r'r Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT 14 SUBJECT TO ALI, CONDITIONS LISTED BELOW: <br /> 0mee+ all 5&kc ® Nab-- n , -f ,1)U►'i v <br /> l+''' (/,4'bef5 Carl 46 � v5e4 �re 4-linn 30 �i 5 r J✓l� q/ 'I f- <br /> �� ✓j( ce .Vci igk-5 d Qtt rot- q l l��w otA.151L:W!Y oc �a M q 05`4'45 c7 <br /> ✓A S'S� ►� c� PcJ Fee Rec: I5O <br /> Q�,- SPs 38 3.3?C i X- i)U c7 <br /> a "" ( I r V 4 Check#. j <br /> &VeC�t 00 CA /1 3 � /uIi4.4 (9/I l a.3 ,'- 14 c n , <br /> 100 y <br /> z <br /> d , <br /> m -- C <br /> Date ofstaff site visit: el/5/2-3 Initi s of site isit staff: ILE < r- �--��— <br /> 11 <br /> APPROVED BY LAND SERVICES OFFICIAL: 0 f DATE:0//6/?3 a <br /> `. <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> r G <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c <br /> Page l of 5 < [j <br /> Burnett County, WI Land Use Application —Rev 5/2023 o (L <br /> H <br /> a <br /> 4 <br /> .b <br />